Child Survival Programmes Research Articles

Operationalizing Integrated Immunization and Family Planning Services in Rural Liberia: Lessons Learned From Evaluating Service Quality and Utilization.

Integration of family planning and immunization services provides an opportunity to meet women's need for postpartum family planning and infants' vaccination needs through client-centered care, while reducing financial and opportunity costs for families. The United States Agency for International Development's Maternal and Child Survival Program (MCSP) supported the Liberia Ministry of Health to scale up integrated family planning and immunization services as part of a broader service delivery and health systems recovery program after the Ebola epidemic. We conducted a mixed-methods program evaluation in 22 health facilities in Grand Bassa and Lofa counties. Family planning uptake and immunization dropout rates at project sites were compared to rates at 18 matched health facilities in the same counties. We conducted 34 focus group discussions with community members and 43 key informant interviews with health care providers and managers to explore quality of care and contextual factors affecting provision and use of integrated services including postpartum family planning. From November 2016 to July 2017, 1,066 women accepted referrals from immunization to family planning counseling (10% of all vaccinator-caregiver interactions); the majority of women who were referred (75%) accepted a family planning method the same day. Trends indicated slightly higher family planning uptake in intervention over nonintervention facilities, but differences were not statistically significant. Pentavalent vaccine dropout rates did not increase in intervention compared to nonintervention facilities indicating no negative impact on utilization of immunization services. Clients and providers expressed that the integrated services reduced costs and time for the clients, educated mothers about postpartum family planning, and ensured infants were completing their vaccinations. Providers expressed the need for increased human resources to meet the elevated demand for family planning counseling services and additional focus on community-level social and behavior change activities. Both groups emphasized that social stigma and norms about postpartum sexual abstinence prevented many women from seeking postpartum family planning services. Although scaling up integrated family planning-immunization services may be programmatically feasible and acceptable to clients and providers, the intervention's success and ability to understand and quantify impact are driven by the effect of contextual factors and fidelity to the intervention approach. Contextual factors need to be understood before implementation, measured during implementation, and addressed throughout implementation to maximize the approach's impact on service utilization and health outcomes.

Streamlining Disease Surveillance System implementation in Tanzania: Lessons Learnt

Streamlining Disease Surveillance System implementation in Tanzania: Lessons Learnt

Suboptimal child spacing practice and its associated factors among women of child bearing age in Serbo town, JIMMA zone, Southwest Ethiopia

IntroductionBirth spacing is the time gaps between two consecutive life births. Optimal spacing until the next pregnancy is the resting period that allows the mother time to recover from pregnancy, and labor. Birth interval of 3 to 5 years increases maternal health and child survival and family planning programs have advocated this birth interval.ObjectivesTo assess prevalence of Suboptimal Child spacing practice and its associated factors among Women of Child bearing age in Serbo town, Jimma Zone Southwest Ethiopia.MethodsCommunity based cross sectional study was conducted on a total of 314 women of child bearing age from March to April 2017 who were selected by simple random sampling. A semi structured questionnaire which was pretested was used to collect the data. Data was checked for completeness and analyzed using SPSS V.20. Bi-variable logistic regression and multi- variable regression were done for predictor variables associated at p-value < 0.05 with the outcome variable.ResultThe prevalence of short birth interval in this study was 59.9%. Independent predictors like age at first marriage (AOR: 2.10, 95% CI = 1.19, 3.69), sex of index child (AOR: 1.964, 95% CI = 1.05 3.96), educational status (AOR: 3.05,95% CI = 1.68, 3.83), duration of breastfeeding (AOR: 3.09, 95% CI = 1.38, 6.96) and use of modern contraceptives (AOR: 1.94, 95% CI = 1.09, 3.45) were found to be statistically associated with short birth interval.Conclusion and recommendationMajority of the study respondents were practicing short birth interval. Education level, age at first marriage, having female child, short duration of breastfeeding and not using of modern contraceptives were factors associated with the outcome variable. Therefore awareness about modern contraceptive utilization, importance of breastfeeding as birth spacing mechanism and impact of early marriage are recommended.

Baby-Friendly Community Initiative-From national guidelines to implementation: A multisectoral platform for improving infant and young child feeding practices and integrated health services.

The Baby‐Friendly Community Initiative (BFCI) is an extension of the 10th step of the Ten Steps of Successful Breastfeeding and the Baby‐Friendly Hospital Initiative (BFHI) and provides continued breastfeeding support to communities upon facility discharge after birth. BFCI creates a comprehensive support system at the community level through the establishment of mother‐to‐mother and community support groups to improve breastfeeding. The Government of Kenya has prioritized community‐based programming in the country, including the development of the first national BFCI guidelines, which inform national and subnational level implementation. This paper describes the process of BFCI implementation within the Kenyan health system, as well as successes, challenges, and opportunities for integration of BFCI into health and other sectors. In Maternal and Child Survival Program (MCSP) and UNICEF areas, 685 community leaders were oriented to BFCI, 475 health providers trained, 249 support groups established, and 3,065 children 0–12 months of age reached (MCSP only). Though difficult to attribute to our programme, improvements in infant and young child feeding practices were observed from routine health data following the programme, with dramatic declines in prelacteal feeding (19% to 11%) in Kisumu County and (37.6% to 5.1%) in Migori County from 2016 to 2017. Improvements in initiation and exclusive breastfeeding in Migori were also noted—from 85.9% to 89.3% and 75.2% to 92.3%, respectively. Large gains in consumption of iron‐rich complementary foods were also seen (69.6% to 90.0% in Migori, 78% to 90.9% in Kisumu) as well as introduction of complementary foods (42.0–83.3% in Migori). Coverage for BFCI activities varied across counties, from 20% to 60% throughout programme implementation and were largely sustained 3 months postimplementation in Migori, whereas coverage declined in Kisumu. BFCI is a promising platform to integrate into other sectors, such as early child development, agriculture, and water, sanitation, and hygiene.

Accelerating progress for complementary feeding in Kenya: Key government actions and the way forward.

Optimal complementary feeding practices, a critical component of infant and young child feeding, has been demonstrated to prevent micronutrient deficiencies, stunting, overweight, and obesity. In Kenya, while impressive gains have been made in exclusive breastfeeding, progress in complementary feeding has been slow, and the country has failed to meet targets. Recent 2014 Kenya Demographic and Health Survey reveal that only 22% of Kenyan children, 6–23 months, met criteria for a minimum acceptable diet. This case study describes key actions for complementary feeding put in place by the Kenya Ministry of Health as well as approaches for improving and monitoring complementary feeding within existing health platforms. Experience from USAID's Maternal and Child Survival Program and Ministry of Health on development of 23 complementary feeding recipes through application of a national guide for recipe development and Trials of Improved Practices is described. Challenges in how to prepare, modify, and cook foods, including meat, for young children 6–23 months of age was relayed by mothers. Addressing cultural beliefs around complementary feeding meant providing reassurance to mothers that young children are developmentally able to digest fruit and vegetables and ready to consume animal‐source protein. Through the Baby Friendly Community Initiative platform, cooking demonstrations and key hygiene actions were integrated with complementary feeding messages. Future programming for complementary feeding should consider development of context specific counselling messages on consumption of animal source foods, strengthen production and use of local foods through agriculture‐nutrition linkages, and include complementary indicators through routine health monitoring systems to track progress.

Rethinking integrated nutrition-health strategies to address micronutrient deficiencies in children under five in Mozambique.

In Mozambique, about two thirds of children 6–59 months of age are affected by vitamin A deficiency and anaemia. The objective of this case study is to provide programme considerations for planning, implementing, monitoring, and evaluating vitamin A and iron deficiency interventions within the context of lessons learned to date for vitamin A supplementation, micronutrient powders (MNPs), and food‐based strategies. For 15 years, the Mozambique Ministry of Health implemented twice‐yearly vitamin A supplementation through both campaigns and routine health services. Yet coverage in 2017 (55%) was not much higher than in 2003 (44%). Reaching every district/reaching every child, a strategy adapted from the field of immunization, was used to achieve equitable coverage of vitamin A and for microplanning of outreach services in health facilities, with support from the Maternal and Child Survival Program. In Mozambique, a free or subsidized distribution model for MNPs has been rolled out, yet integration of MNPs into infant and young child feeding programming (i.e., cooking demonstrations) is needed to reinforce “the who, what, and why” of MNPs through culturally sensitive behaviour change communication. Food‐based strategies to promote dietary diversity, such as through complementary feeding recipes, are also critical. To harmonize efforts, the Mozambique government should consider the development of a national strategy for the prevention and control of micronutrient malnutrition, with clear monitoring and evaluation targets. Ongoing monitoring of the prevalence of micronutrient deficiencies and coverage of implemented micronutrient interventions is needed to make evidence‐based decisions to drive nutrition–health programming.

Outcomes of the Expanded Programme on Immunization Pre-Service Training Initiatives in Kenya: A Mixed Methods Study

Background: The Maternal and Child Survival Program of United States Agency for International Development conducted a study in 2017 to assess the outcome of an initiative to strengthen Expanded Programme on Immunization (EPI) pre-service training. The pre-service training initiative was undertaken by the Ministry of Health (MOH) with support from partners in 2012-2016. The overall objective of the study was to assess the adoption and effectiveness of the initiative in the competency (knowledge, skills and attitude) of graduate nurses. Methods: The study included a conveniently selected sample of 14 pre-service training institutions, 23 field practicum sites, and 29 health facilities in western Kenya, and used quantitative and qualitative methods of data collection. Results: All pre-service training institutions were found to have adapted the WHO EPI prototype curriculum. Overall, tutors followed training method in the classroom as suggested in the curriculum, except evaluation of students’ learning lacked tests or quizzes. Students had opportunities for hands-on practical experience in the field practicum sites. Graduate nurses were found to have acquired the skills for vaccinating children. However, some pre-service training institutions lacked functional skills labs for practical learning of students. In addition, students did not receive up-to-date information on EPI program, and lacked knowledge and skills on monitoring and documentation of EPI coverage during preservice training. Conclusions: It appears that the EPI pre-service training strengthening initiatives facilitated competency-based EPI training of nurses in Kenya. However, preservice training institutions still have scope for improvement in the skills lab, hand-washing practice, providing up-to-date information, and training students on coverage monitoring and documentation.

The revitalization and scale-up of the Baby-Friendly Hospital Initiative in Malawi.

The Baby‐Friendly Hospital Initiative (BFHI) has shown to strengthen health providers' skills in the provision of breastfeeding counselling and support, which have led to improvements in breastfeeding outcomes. In Malawi, where BFHI was introduced in 1993 but later languished due to losses in funding, the Maternal and Child Survival Program supported the Malawi Ministry of Health (MOH) in the revitalization and scale‐up of BFHI in 54 health facilities across all 28 districts of the country. This paper describes the revitalization and scale‐up process within the context of an integrated health project; successes, challenges, and lessons learned with BFHI implementation; and the future of BFHI in Malawi. More than 80,000 mothers received counselling on exclusive breastfeeding following childbirth prior to discharge from the health facility. Early initiation of breastfeeding was tracked quarterly from baseline through endline via routine MOH health facility data. Increases in early initiation of breastfeeding were seen in two of the three regions of Malawi: by 2% in the Central region and 6% in the Southern region. Greater integration of BFHI into Malawi's health system is recommended, including improved preservice and in‐service trainings for health providers to include expanded BFHI content, increased country financial investments in BFHI, and integration of BFHI into national clinical guidelines, protocols, and nutrition and health policies.

Maternal Factors and Utilization of the Antenatal Care Services during Pregnancy Associated with Low Birth Weight in Rural Nepal: Analyses of the Antenatal Care and Birth Weight Records of the MATRI-SUMAN Trial.

Low birth weight (LBW) remains a major public health problem in developing countries, including Nepal. This study was undertaken to examine the association between LBW and maternal factors and antenatal care service utilization, in rural Nepal, using data obtained for a capacity-building and text-messaging intervention, designed to enhance maternal and child health service utilization among pregnant women, in rural Nepal (“MATRI-SUMAN”). The study used a clustered randomized controlled design and was conducted during 2015–2016. We investigated maternal and antenatal care service utilization determinants of LBW, using a logistic regression model. Of the four hundred and two singleton babies, included in the present study, seventy-eight (19.4%) had an LBW (mean (SD), 2210.64 (212.47)) grams. It was found that Dalit caste/ethnicity, illiteracy, manual labor, a female baby, and having more than four family members were significantly positively associated with LBW. In addition, mothers who did not visit an antenatal care (ANC) unit, visited an ANC < 4 times, did not take iron and folic acid (IFA), de-worming tablets, and mothers that did not consume additional food, during pregnancy, were more likely to have an LBW baby, than their counterparts. The MATRI-SUMAN intervention and availability of a kitchen garden at home, were found to reduce the risk of LBW. Nepalese child survival policies and programs should pay attention to these maternal and antenatal care service utilization factors, while designating preventive strategies to improve child health outcomes.

Developmental disabilities among children younger than 5 years in 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016.

SummaryBackgroundThe Sustainable Development Goals (SDGs) mandate systematic monitoring of the health and wellbeing of all children to achieve optimal early childhood development. However, global epidemiological data on children with developmental disabilities are scarce. The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 provides a comprehensive assessment of prevalence and years lived with disability (YLDs) for development disabilities among children younger than 5 years in 195 countries and territories from 1990 to 2016.MethodsWe estimated prevalence and YLDs for epilepsy, intellectual disability, hearing loss, vision loss, autism spectrum disorder, and attention deficit hyperactivity disorder. YLDs were estimated as the product of the prevalence estimate and the disability weight for each mutually exclusive disorder, corrected for comorbidity. We used DisMod-MR 2.1, a Bayesian meta-regression tool, on a pool of primary data derived from systematic reviews of the literature, health surveys, hospital and claims databases, cohort studies, and disease-specific registries.FindingsGlobally, 52·9 million (95% uncertainty interval [UI] 48·7–57·3; or 8·4% [7·7–9·1]) children younger than 5 years (54% males) had developmental disabilities in 2016 compared with 53·0 million (49·0–57·1; or 8·9% [8·2–9·5]) in 1990. About 95% of these children lived in low-income and middle-income countries. YLDs among these children increased from 3·8 million (95% UI 2·8–4·9) in 1990 to 3·9 million (2·9–5·2) in 2016. These disabilities accounted for 13·3% of the 29·3 million YLDs for all health conditions among children younger than 5 years in 2016. Vision loss was the most prevalent disability, followed by hearing loss, intellectual disability, and autism spectrum disorder. However, intellectual disability was the largest contributor to YLDs in both 1990 and 2016. Although the prevalence of developmental disabilities among children younger than 5 years decreased in all countries (except for North America) between 1990 and 2016, the number of children with developmental disabilities increased significantly in sub-Saharan Africa (71·3%) and in North Africa and the Middle East (7·6%). South Asia had the highest prevalence of children with developmental disabilities in 2016 and North America had the lowest.InterpretationThe global burden of developmental disabilities has not significantly improved since 1990, suggesting inadequate global attention on the developmental potential of children who survived childhood as a result of child survival programmes, particularly in sub-Saharan Africa and south Asia. The SDGs provide a framework for policy and action to address the needs of children with or at risk of developmental disabilities, particularly in resource-poor countries.FundingThe Bill & Melinda Gates Foundation.

Performance of Ashas in ANC and Birth Planning in Uttar Pradesh, India

ASHAs were introduced in UP through NRHM in 2005, the first major task of ASHAs was to focus on maternal and child health to reduce Maternal Mortality Ratio and Infant Mortality Rate in the state of UP. Their primary activity was to visit homes of pregnant women. The first program in UP operated through the ASHAs was the Comprehensive Child Survival Program in 2008. Since then, tracking of all pregnancies to decipher messages on ANC and birth planning is an integral part of the work of ASHAs across the state of UP. &#x0D; The current study explores variables like the average visits of each of the ASHAs to pregnant women in absolute numbers in four districts of UP. Further, the study sees the percentage of the ASHAs that give messages on ANC like TT injections, BP and abdominal examination, IFA tablets and provision of 3 ANCs to pregnant women. In addition to that, the percentage of ASHAs giving messages on birth planning like identification of place of delivery, birth attendant, arranging money, arranging transport and identification of blood donor. Information on JSY was also a part of the message. These activities were done by the ASHAs in the last 3 months prior to the survey. &#x0D; &#x0D; The relevance of the study assumes significance as data on the details of targeted messages done by ASHAs through home visits are never discussed in detail and further there is no comparison to their performance visa vis the inputs they received through capacity building.&#x0D; &#x0D; A total of four districts of Uttar Pradesh were selected purposively for the study and the data collection was conducted in the villages of the respective districts with the help of a pre-tested structured interview schedule with both close-ended and open-ended questions. In addition, in-depth interviews were also conducted amongst the ASHAs and a total 250 respondents had participated in the study.&#x0D; The numbers of pregnant women visited by each of the ASHAs in the 4 districts in their catchment area in the 3 months were in the range of 4-6. Among the messages on ANC, IFA tablets consumption and TT injections were given by most of the ASHAs in the 4 districts. Among the birth planning messages, identification of place and birth attendant were given by most of the ASHAs in the 4 districts. This reflected that the focus of messages were neither prioritized nor covered by all the ASHAs.

Prevention of Congenital Syphilis Through Antenatal Screenings in Lusaka, Zambia: A Systematic Review

Congenital syphilis is one of the preventable diseases caused by the gram-negative bacteria Treponema pallidum; yet, it imposes a serious global health and economic burden, with more than half of the cases resulting in serious adverse outcomes, including infant mortality. Mother-to-child transmission (MTCT) of syphilis is estimated at 3.6 million adjusted life years (DALYs) and around $309 million in medical costs. In 2006, an estimated 9.7 million children of age less than five years died in developing countries; almost four million were neonatal deaths. There were 3.2 million stillbirths globally, among whom 95% were in the developing countries. In sub-Saharan Africa, there is an estimated 2.7% (0.1%-10.3%) of pregnant women infected with syphilis, representing more than 900,000 pregnancies at risk each year. There were many non-specific and specific diagnostic tests used in the past, which required laboratory equipment and electricity, but there are many newer tests available now that provide rapid results with high sensitivity and specificity, e.g., the immunochromatographic strip (ICS) and rapid syphilis tests (RST). Early syphilis can be completely eliminated with a single injection of penicillin, which is readily available, cheap, and highly effective, and treating pregnant women with penicillin is 98% effective at preventing congenital syphilis. Targeting women at a high risk of having syphilis makes universal screening in antenatal programs the most efficacious way to prevent syphilis-associated morbidity and mortality. The potential for a program to prevent congenital syphilis in the perinatal, neonatal, and postnatal periods is evident. While considering resource allocation to child survival programs in areas where the prevalence of syphilis is high, officials need to include antenatal syphilis screening, using rapid tests and treatment at the first contact of the mother with the health care system. In countries like Zambia and other resource-limited settings, a same-day test and treatment with penicillin should be prioritized to achieve the goal of eliminating congenital syphilis. Eliminating MTCT of syphilis through screening and treatment in antenatal care (ANC) is highly cost-effective in a wide range of settings, especially in countries with a high prevalence.

A study on immunization coverage of 12-23 months children in urban areas of Kanchipuram district, Tamil Nadu

Background: Immunization forms the major focus of child survival program throughout the world. Roughly 3 million children die each year of Vaccine Preventable Diseases (VPDs) with a disproportionate number of these children residing in developing countries. Majority of the population in rural areas depend mainly on Govt. agencies for health care, including immunization. Whereas, in urban areas in spite of multiple agencies providing health care. Hence, the present study was carried out in urban areas of Kanchipuram district to know the current level of immunization status and also the reasons for failure in immunization. The objectives of the study were to assess the immunization coverage among children 12-23 months in municipality areas of Kanchipuram district, to find out the reasons for non immunization or partial immunization and to recommend measures to improve the immunization coverageMethods: 30/7 cluster technique by using immunization program coverage survey household form. Results: Out of 210 study population, 130 (61.5%) were boys and 80 (38.5%) were girls. 115(55%) children were from Hindu community, 47 (22%) Muslims and 48 (23%) Christians. The mothers who were able to show the card to the investigator was 122 (58%), whereas the rest (88) 42% of the mothers were not able to produce the card during the day of survey. The percentage of fully immunized was 160 (76%), partially immunized was 50 (24%). Conclusions: As immunization forms a critical component of primary health care, at most importance needs to be given to the same so that child will not be deprived of the precious drop or prick. Every opportunity should be used to vaccinate eligible children by overcoming the hurdles, to achieve the goal of 100% immunization coverage.

A comprehensive analysis on child mortality and its determinants in Bangladesh using frailty models

BackgroundBangladesh has experienced a significant reduction of child mortality over the past decades which helped achieve the Millennium Development Goal 4 (MDG 4) target. But the mortality among under-5 aged children is still relatively high and it needs a substantial effort to achieve the Sustainable Development Goal (SDG) target and decelerate the current rate of under-5 mortality. At this stage, it is hence important to explore the trend and determinants of under-5 mortality in order to reduce the vulnerability of child’s survival. The aim of this study is to explore the trends and identify the factors associated with mortality in children aged less than 5 years in Bangladesh.MethodsData from three repeatedly cross-sectional Bangladesh Demographic and Health Surveys (BDHSs) for the year 2007, 2011 and 2014 were used. A stratified two-stage sampling method was used to collect information on child and maternal health in these surveys. Cox’s proportional hazards models with community and mother level random effects (or frailty models) were fitted to identify the associated factors with under-five mortality.ResultsOur study reveals that urban-rural disparity in child mortality has decreased over the time. The frailty models revealed that the combined effect of birth order and preceding birth interval length, sex of the child, maternal age at birth, mother’s working status, parental education were the important determinants associated with risk of child mortality. The risk of mortality also varied across divisions with Sylhet division being the most vulnerable one. Moreover, significant and sizable frailty effects were found which indicates that the estimations of the unmeasured and unobserved mother and community level factors on the risk of death were substantively important.ConclusionOur study suggests that community-based educational programs and public health interventions focused on birth spacing may turn out to be the most effective. Moreover, unobserved community and familial effects need to be considered along with significant programmable determinants while planning for the child survival program.

Cross sectional study of immunization coverage in urban slum areas of Lucknow region

Background: Immunization plays an important role of child survival programmes all over the world. Recent data revealed that there are approximately 34 million children are not completely immunized and about 98% are residing in developing countries. The aims and objectives were to assess the immunization coverage and various socio-demographic factors affecting the immunization in urban slum areas of Lucknow.Methods: A cross-sectional study was carried out at urban slums of Lucknow region. The target study population was of children aged 0-6 years. The immunization status data of the child was collected and analysed.Results: Majority (79.8%) of children were in the age group of 16-23 months. Majority (79.4%) of children were completely immunized, while 20.6% were partially immunized. Significant association was found between educational status of mother and socioeconomic status of family with immunization status of children.Conclusions: There was significant association was found between educational status of mother and socioeconomic status of family with immunization status of children. We observed in present study that there are some pockets in slum areas where immunization to children are very poor.

Developing a Mentorship Program in Laos.

Skills strengthening and capacity building for maternal and newborn health (MNH) providers are essential to ensure quality care for mothers and newborns. There is, however, limited research regarding what constitutes an effective model in low-income countries. The Lao People’s Democratic Republic (Laos) has some of the region’s worst outcomes for neonatal and maternal mortality. Moreover, with a 23-year hiatus in midwifery training, which ended approximately 7 years ago, there is a cadre of new and inexperienced midwives in practice without support systems, skills, or continuing professional development opportunities. Traditional didactic teaching methodologies prevail in Laos, but with little evidence of efficacy. As an alternative model, Save the Children International has been implementing a mentorship approach for MNH providers in two provinces in northern Laos since January 2016, with technical guidance and funding from the United States Agency for International Development-supported global Maternal Child Survival Program. This community case study will describe and reflect on the approach by highlighting the need and rationale for mentorship, followed by a description of the program’s core components and the results observed so far. Lessons learned and the application of the approach to different contexts and health-care professionals, considering both constraints and opportunities, will be discussed.

Severe Visual Impairment and Blindness among Children in Mbarali district, Southern Tanzania: Prevalence and types

BackgroundThe prevalence of severe visual-impairment (SVI) and blindness (BL) in children is related to under-five mortality rates which have reduced in Tanzania. The prevalence and types of SVI-and-BL in Mbarali district is not known. We aimed to determine the prevalence and the types of SVI-and-BL among children in Mbarali district, Mbeya, Tanzania.MethodsA population based cross-sectional survey was conducted from March 2016 to April 2016 among children less than 16 years in all villages of Mbarali district. A total of 113 village health workers one from each village were trained to identify children with poor vision of 5 years. It is likely that preventable SVI and blindness have been reduced by successful child survival programs. In order to eliminate avoidable SVI-and-BL, Tertiary eye-services for children need be established at Mbeya Zonal Referral hospital to combat treatable SVI-and-BL.

Child mortality inequalities across Rwanda districts: a geoadditive continuous-time survival analysis.

Child survival programmes are efficient when they target the most significant and area-specific factors. This study aimed to assess the key determinants and spatial variation of child mortality at the district level in Rwanda. Data from the 2010 Rwanda Demographic and Health Survey were analysed for 8817 live births that occurred during five years preceding the survey. Out of the children born, 433 had died before survey interviews were carried out. A full Bayesian geo-additive continuous-time hazard model enabled us to maximise data utilisation and hence improve the accuracy of our estimates. The results showed substantial district- level spatial variation in childhood mortality in Rwanda. District-specific spatial characteristics were particularly associated with higher death hazards in two districts: Musanze and Nyabihu. The model estimates showed that there were lower death rates among children from households of medium and high economic status compared to those from low-economic status households. Factors, such as four antenatal care visits, delivery at a health facility, prolonged breastfeeding and mothers younger than 31 years were associated with lower child death rates. Long preceding birth intervals were also associated with fewer hazards. For these reasons, programmes aimed at reducing child mortality gaps between districts in Rwanda should target maternal factors and take into consideration district-specific spatial characteristics. Further, child survival gains require strengthening or scaling-up of existing programmes pertaining to access to, and utilisation of maternal and child health care services as well as reduction of the household gap in the economic status.

Health facility management and access: a qualitative analysis of challenges to seeking healthcare for children under five in Uganda.

While several studies have documented the various barriers that caretakers of children under five routinely confront when seeking healthcare in Uganda, few have sought to capture the ways in which caretakers themselves prioritize their own barriers to seeking services. To that end, we asked focus groups of caretakers to list their five greatest challenges to seeking care on behalf of children under five. Using qualitative content analysis, we grouped responses according to four categories: (1) geographical access barriers; (2) facility supplies, staffing, and infrastructural barriers; (3) facility management and administration barriers (e.g. health worker professionalism, absenteeism and customer care); and (4) household barriers related to financial circumstances, domestic conflicts with male partners and a stated lack of knowledge about health-related issues. Among all focus groups, caretakers mentioned supplies, staffing and infrastructure barriers most often and facility management and administration barriers the least. Caretakers living furthest from public facilities (8–10 km) more commonly mentioned geographical barriers to care and barriers related to financial and other personal circumstances. Caretakers who lived closest to health facilities mentioned facility management and administration barriers twice as often as those who lived further away. While targeting managerial barriers is vitally important—and increasingly popular among national planners and donors–it should be done while recognizing that alleviating such barriers may have a more muted effect on caretakers who are geographically harder to reach – and by extension, those whose children have an increased risk of mortality. In light of calls for greater equity in child survival programming – and given the limited resource envelopes that policymakers often have at their disposal – attention to the barriers considered most vital among caretakers in different settings should be weighed.

Geographic information system for improving maternal and newborn health: recommendations for policy and programs

This correspondence argues and offers recommendations for how Geographic Information System (GIS) applied to maternal and newborn health data could potentially be used as part of the broader efforts for ending preventable maternal and newborn mortality. These recommendations were generated from a technical consultation on reporting and mapping maternal deaths that was held in Washington, DC from January 12 to 13, 2015 and hosted by the United States Agency for International Development’s (USAID) global Maternal and Child Survival Program (MCSP). Approximately 72 participants from over 25 global health organizations, government agencies, donors, universities, and other groups participated in the meeting.The meeting placed emphases on how improved use of mapping could contribute to the post-2015 United Nation’s Sustainable Development Goals (SDGs), agenda in general and to contribute to better maternal and neonatal health outcomes in particular. Researchers and policy makers have been calling for more equitable improvement in Maternal and Newborn Health (MNH), specifically addressing hard-to-reach populations at sub-national levels. Data visualization using mapping and geospatial analyses play a significant role in addressing the emerging need for improved spatial investigation at subnational scale. This correspondence identifies key challenges and recommendations so GIS may be better applied to maternal health programs in resource poor settings. The challenges and recommendations are broadly grouped into three categories: ancillary geospatial and MNH data sources, technical and human resources needs and community participation.