Improve Child Survival Research Articles

Infant and young child feeding practices and its associated factors among mothers of under two years children in a western hilly region of Nepal.

Infant and young child feeding is a key area to improve child survival and promote healthy growth and development. Nepal government has developed and implemented different programs to improve infant and young child feeding practice. However, the practice remains poor and is a major cause of malnutrition in Nepal. This study aims to identify infant and young child feeding practices and its associated factors among mothers of children aged less than two years in western hilly region of Nepal. A descriptive cross-sectional study was carried out among 360 mothers of under two years' children in Syangja district. A semi structural questionnaire was used. Data was entered in EpiData and analyzed using IBM SPSS version 21. Descriptive statistics were used to report the feeding practices and other independent variables. Bivariate and multivariate logistic regression model was used to establish the factors associated with infant and young child feeding practices. The prevalence of breastfeeding, timely initiation of breastfeeding, exclusive breastfeeding, timely initiation of complementary feeding, minimum dietary diversity, minimum meal frequency and minimum acceptable diet (MAD) were 95.6%, 69.2%, 47.6%, 53.3%, 61.5%, 67.3% and 49.9% respectively. Normal delivery (AOR 6.1, 95% CI 1.2-31.3) and higher maternal autonomy (AOR 5.2, 95% CI 1.8-14.6) were significantly associated with exclusive breastfeeding. Similarly, crop production and food security (AOR 3.8, 95% CI 1.9-7.7), maternal knowledge on MAD (AOR 2.5, 95% CI 1.0-6.2) and maternal autonomy (AOR 4.2, 95% CI 2.1-8.4) were significantly associated with minimum acceptable diet. Factors such as maternal education, maternal health services utilization, maternal knowledge, and maternal autonomy were associated with infant and young child feeding practices, which warrants further attention to these factors to reduce malnutrition.

Commentary to clinical significance of tumoral PD-L1 expression in wilms tumor

The remarkable improvement in survival of children with Wilms tumor over the past half century rests on the combined use of surgery, chemotherapy and radiotherapy with risk stratified protocols, with risk stratification based on the independently prognostic variables of tumor stage and histology. Ninety percent of children with Wilms tumor now survive with the use of these risk-adapted treatment protocols, protocols which aim to achieve maximal survival with minimal short and long term toxicity of treatment.

Preterm neonatal mortality in China during 2009-2018: A retrospective study.

In this retrospective analysis, we aimed to analyze the epidemic characteristics of neonatal mortality due to preterm birth at 28–36 weeks gestation in different regions from 2009 to 2018. Data were obtained from China’s Under-5 Child Mortality Surveillance System (U5CMSS). The χ2 trend test, Poisson regression and the Cochran-Mantel-Haenszel method were used in this study. We found that 51.3%, 42.0% and 44.5% of neonate deaths were preterm infants, and immaturity was mainly attributed to 60.1%, 64.1% and 69.5% of these deaths, in the eastern, central and western regions, respectively. The preterm neonatal mortality rate due to immaturity dropped from 149.2, 216.5 and 339.5 in 2009 to 47.4, 83.8 and 170.1 per 100 000 live births in 2018, giving an average annual decline rate of 12.1%, 11.6% and 6.3% in the eastern, central and western regions, respectively, during the studying period. The relative risk of preterm neonatal mortality due to immaturity were 1.3 and 2.3 for the central regions and western regions in 2009–2010, ascending to 2.2 and 3.9 in 2017–2018. The proportion of preterm neonatal deaths with a gestational age <32 weeks was highest among the eastern region. There were significantly more preterm neonatal infants who were not delivered at medical institutions in the western region than in the eastern and central regions. The preterm infant, especially with gestational age <32 weeks, should receive the most attention through enhanced policies and programs to improve child survival. Priority interventions should be region-specific, depending on the availability of economic and healthcare resources.

Maternal HPV Infection: Effects on Pregnancy Outcome.

The human papilloma virus (HPV) infection, caused by a ubiquitous virus typically transmitted through the direct contact of infected organs, either through the skin or mucosa, is the most common sexually transmitted infection, placing young women at a high risk of contracting it. Although the vast majority of cases spontaneously clear within 1–2 years, persistent HPV infection remains a serious concern, as it has repeatedly been linked to the development of multiple malignancies, including cervical, anogenital, and oropharyngeal cancers. Additionally, more recent data suggest a harmful effect of HPV infection on pregnancy. As the maternal hormonal environment and immune system undergo significant changes during pregnancy, the persistence of HPV is arguably favored. Various studies have reported an increased risk of adverse pregnancy outcomes among HPV-positive women, with the clinical impact encompassing a range of conditions, including preterm birth, miscarriage, pregnancy-induced hypertensive disorders (PIHD), intrauterine growth restriction (IUGR), low birth weight, the premature rupture of membranes (PROM), and fetal death. Therefore, understanding the mechanisms employed by HPV that negatively impact pregnancy and assessing potential approaches to counteract them would be of interest in the quest to optimize pregnancy outcomes and improve child survival and health.

Are maternal and child health initiatives helping to reduce under-five mortality in Ghana? Results of a quasi-experimental study using coarsened exact matching

BackgroundDespite a 53 % decline in under-five mortality (U5M) worldwide during the period of the Millennium Development Goals (MDGs), U5M remains a challenge. Under-five mortality decline in Ghana is slow and not parallel with the level of coverage of child health interventions. The interventions promoted to improve child survival include early initiation of breastfeeding, clean postnatal care, and skilled delivery. This study sought to assess the effectiveness of these interventions on U5M in Ghana.MethodsA quasi-experimental study was conducted using secondary data of the 2008 and 2014 Ghana Demographic and Health Surveys. Coarsened Exact Matching and logistic regression were done. The interventions assessed were iron intake, early initiation of breastfeeding, clean postnatal care, hygienic disposal of stool, antenatal care visits, skilled delivery, intermittent preventive treatment of malaria in pregnancy, and tetanus toxoid vaccine.ResultsThere were 2,045 children under-five years and 40 (1.9 %) deaths in 2008. In 2014, the total number of children under-five years was 4,053, while deaths were 53(1.2 %). In 2014, children less than one month old formed 1.6 % of all children under-five years, but 47.8 % of those who died. Mothers who attended four or more antenatal care visits were 78.2 % in 2008 and 87.0 % in 2014. Coverage levels of improved sanitation and water connection in the home were among the lowest, with 11.6 % for improved sanitation and 7.3 % for water connection in the home in 2014. Fifty-eight (58), 1.4 %, of children received all the eight (8) interventions in 2014, and none of those who received all these interventions died. After controlling for potential confounders, clean postnatal care was associated with a 66% reduction in the average odds of death (aOR = 0.34, 95 %CI:0.14–0.82), while early initiation of breastfeeding was associated with a 62 % reduction in the average odds of death (aOR = 0.38, 95 % CI: 0.21–0.69).ConclusionsTwo (clean postnatal care and early initiation of breastfeeding) out of eight interventions were associated with a reduction in the average odds of death. Thus, a further decline in under-five mortality in Ghana will require an increase in the coverage levels of these two high-impact interventions.

Consistency of the determinants of achieving fertility desires in Ghana: insights from 2003, 2008 and 2014 Ghana Demographic and Health Survey data sets

Sub-Saharan Africa has entered the early stage of the demographic transition with differences in and between countries. The relation between fertility preference and actual fertility is at the core of the demographic changes during the demographic transition in sub-Saharan Africa. At the current pace of the demographic transition, overachieved fertility (actual fertility being higher than fertility preference) is more prevalent in sub-Saharan Africa although some women do achieve their fertility preference. Our aim is to assess the trends and identify factors that consistently influence women with completed fertility to achieve their fertility desires in Ghana over a 10-year period. We used secondary data from the 2003, 2008 and 2014 Ghana Demographic and Health Surveys for the analysis. The sample size was restricted to currently married/living in union women aged 45–49 years. The results indicate that underachieved fertility has increased from 25.1% in 2003 to 35.8% in 2014. Similarly, achieved fertility has also increased from 23.8% in 2003 to 26.0% in 2014. On the contrary, overachieved fertility has decreased from 51.1% in 2003 to 38.2% in 2014. The most persistent determinants of achieved fertility relative to overachieved fertility in Ghana during the last three rounds of the Ghana Demographic and Health Surveys are child survival status, ethnicity and couple’s fertility preference. The study provides support for programmatic interventions targeting improving child survival and regulating men’s fertility preference.

Associations between cesarean delivery and child mortality: A national record linkage longitudinal study of 17.8 million births in Brazil.

There is an increasing use of cesarean delivery (CD) based on preference rather than on medical indication. However, the extent to which nonmedically indicated CD benefits or harms child survival remains unclear. Our hypothesis was that in groups with a low indication for CD, this procedure would be associated with higher child mortality and in groups with a clear medical indication CD would be associated with improved child survival chances. We conducted a population-based cohort study in Brazil by linking routine data on live births between January 1, 2012 and December 31, 2018 and assessing mortality up to 5 years of age. Women with a live birth who contributed records during this period were classified into one of 10 Robson groups based on their pregnancy and delivery characteristics. We used propensity scores to match CD with vaginal deliveries (1:1) and prelabor CD with unscheduled CD (1:1) and estimated associations with child mortality using Cox regressions. A total of 17,838,115 live births were analyzed. After propensity score matching (PSM), we found that live births to women in groups with low expected frequencies of CD (Robson groups 1 to 4) had a higher death rate up to age 5 years if they were born via CD compared with vaginal deliveries (HR = 1.25, 95% CI: 1.22 to 1.28; p < 0.001). The relative rate was greatest in the neonatal period (HR = 1.39, 95% CI: 1.34 to 1.45; p < 0.001). There was no difference in mortality rate when comparing offspring born by a prelabor CD to those born by unscheduled CD. For the live births to women with a CD in a prior pregnancy (Robson group 5), the relative rates for child mortality were similar for those born by CD compared with vaginal deliveries (HR = 1.05, 95% CI: 1.00 to 1.10; p = 0.024). In contrast, for live births to women in groups with high expected rates of CD (Robson groups 6 to 10), the child mortality rate was lower for CD than for vaginal deliveries (HR = 0.90, 95% CI: 0.89 to 0.91; p < 0.001), particularly in the neonatal period (HR = 0.84, 95% CI: 0.83 to 0.85; p < 0.001). Our results should be interpreted with caution in clinical practice, since relevant clinical data on CD indication were not available. In this study, we observed that in Robson groups with low expected frequencies of CD, this procedure was associated with a 25% increase in child mortality. However, in groups with high expected frequencies of CD, the findings suggest that clinically indicated CD is associated with a reduction in child mortality.

Primary Health Care, Proverbs, and Promise? Improving Child Survival in Northern Togo.

* Abbreviations: GPH — : global public health NMR — : neonatal mortality rate PHC — : primary health care U5MR — : under-5 mortality rate > Wood already touched by fire is not hard to set alight. > > Akan Proverb The use of proverbs in Africa is a powerful communication tool. Proverbs alert the listener to the importance of a topic and convey ancestral wisdom often with richly evocative imagery. The beauty of proverbs is their universal and timeless truths, which incorporate multiple interpretations across domains, cultures, and countries. It is fitting to use the interpretations of this West African (Akan) proverb “Wood already touched by fire is not hard to set alight” as a framework to comment on the study in Pediatrics by Fiori et al,1 who report the impact of a pragmatic, effectiveness primary health care (PHC) suite of interventions across 10 022 households over a 5-year period in Kara, a low-resource region of northern Togo, West Africa. The authors report on mortality, health use, quality and coverage outcomes, and cost. ### Interpretation 1: In the Right Setting, a Good Idea Can Easily Translate Into Reality This year marks the 43rd anniversary of the landmark Alma-Ata Declaration, which codified PHC as the key pillar and strategy all countries should adopt to ensure improved health for all.2 Introducing a suite of interventions into global public health (GPH) to attain multiplicative benefit has long been an attractive yet elusive goal, and in … Address correspondence to Cyril Engmann, MD, FAAP, Department of Pediatrics, School of Medicine, University of Washington, Health Sciences Building, 1959 NE Pacific St, Seattle, WA 98195. E-mail: cengmann{at}uw.edu

Effects of community-based interventions on exclusive breastfeeding among lactating women: a systematic review

Improvement in the exclusive breastfeeding (EBF) rates until 6 months have been proved to be a major contributor in the improvement of child survival over last two decades because EBF provides optimal nutrition for early life. However, most of the low-income countries (LIC) and low-middle income countries (LMIC) are below the 90% benchmark set by World Health Organization. Evidence regarding CBIs for EBF among lactating women with infants &lt;6 m was searched in PubMed and Cochrane library. Studies from LICs and LMICs that reported EBF until 6 months as outcomes were included and their results were analysed. Data extraction included characteristics of the studies and full summary that involved the effect of interventions on the outcomes. Of 5,530 studies initially identified, 25 studies were included for the systematic review. The interventions were community-based that focused on breastfeeding practices among lactating women with infants &lt;6 m. The studies were geographically diverse-involved LICs (n=7) and LMICs (n=11). The population ranged from n=12 to 26,262. Of 25 studies, five types of interventions reported- counselling interventions (n=14), training to peer counsellors (n=2), mass media interventions (n=5), mobile phone Interventions (n=1), and EBF promotion and education (n=3). CBIs could substantially increase the rates of EBF. The review identified five types of CBIs, indicating that there are different ways through which high EBF rates could be achieved. Counselling intervention was more effective but other interventions have also shown significant results in improving BF practices.

Infant and Young Child Feeding Practices among Adolescent Mothers and Associated Factors in India.

Adequate infant and young child feeding (IYCF) improve child survival and growth. Globally, about 18 million babies are born to mothers aged 18 years or less and have a higher likelihood of adverse birth outcomes in India due to insufficient knowledge of child growth. This paper examined factors associated with IYCF practices among adolescent Indian mothers. This cross-sectional study extracted data on 5148 children aged 0–23 months from the 2015–2016 India National Family Health Survey. Survey logistic regression was used to assess factors associated with IYCF among adolescent mothers. Prevalence of exclusive breastfeeding, early initiation of breastfeeding, timely introduction of complementary feeding, minimum dietary diversity, minimum meal frequency, and minimum acceptable diet rates were: 58.7%, 43.8%, 43.3%, 16.6%, 27.4% and 6.8%, respectively. Maternal education, mode of delivery, frequency of antenatal care (ANC) clinic visits, geographical region, child’s age, and household wealth were the main factors associated with breastfeeding practices while maternal education, maternal marital status, child’s age, frequency of ANC clinic visits, geographical region, and household wealth were factors associated with complementary feeding practices. IYCF practices among adolescent mothers are suboptimal except for breastfeeding. Health and nutritional support interventions should address the factors for these indicators among adolescent mothers in India.

Nutritional Support in Malnourished Children With Compromised Gastrointestinal Function: Utility of Peptide-Based Enteral Therapy.

This review focuses on nutritional support in malnourished children with compromised gastrointestinal function addressing the interplay between malnutrition and gastrointestinal dysfunction, and the specific role of peptide-based enteral therapy in pediatric malnutrition. Malnutrition is associated with impaired gut functions such as increased intestinal permeability, malabsorption, and diarrhea, while pre-existing functional gastrointestinal disorders may also lead to malnutrition. Presence of compromised gastrointestinal function in malnourished children is critical given that alterations such as malabsorption and increased intestinal permeability directly interfere with efficacy of nutritional support and recovery from malnutrition. Appropriate nutritional intervention is the key step in the management of malnutrition, while alterations in gastrointestinal functions in malnourished children are likely even in those with mild degree malnutrition. Therefore, nutritional therapy in children with compromised gastrointestinal function is considered to involve gut-protective interventions that address the overlapping and interacting effects of diarrhea, enteropathy and malnutrition to improve child survival and developmental potential in the long-term. Peptide-based enteral formulas seem to have clinical applications in malnourished children with compromised gastrointestinal function, given their association with improved gastrointestinal tolerance and absorption, better nitrogen retention/ balance, reduced diarrhea and bacterial translocation, enhanced fat absorption, and maintained/restored gut integrity as compared with free amino acid or whole-protein formulas.

Are fathers a good substitute for mothers? Paternal care and growth rates in Shodagor children.

Biparental care is a hallmark of human social organization, though paternal investment varies between and within societies. The facultative nature of paternal care in humans suggests males should invest when their care improves child survival and/or quality, though testing this prediction can be challenging because of the difficulties of empirically isolating paternal effects from those of other caregivers. Additionally, the broader context in which care is provided, vis-à-vis care from mothers and others, may lead to different child outcomes. Here, we examine the effects of paternal care on child growth among Shodagor fisher-traders, where fathers provide high levels of both additive and substitutive care, relative to mothers. We modeled seasonal z-scores and velocities for height, weight, and body mass index (BMI) outcomes using linear mixed models. Our evidence indicates that, as predicted, the context of paternal care is an important predictor of child outcomes. Results show that environmental seasonality and alloparental help contribute to a nuanced understanding of the impact of Shodagor paternal care on child physiology.

Survival and predictors of mortality among severe acute malnourished under-five children admitted at Felege-Hiwot comprehensive specialized hospital, northwest, Ethiopia: a retrospective cohort study

BackgroundMalnutrition is still a global public health problem contributing for under-five morbidity and mortality. The case is similar in Ethiopia in which severe acute malnutrition is the major contributor to mortality being an underlying cause for nearly 45% of under-five deaths. However, there is no recent evidence that shows the time to death and public health importance of oxygen saturation and chest in drawing in the study area. Therefore, estimated time to death and its predictors can provide an input for program planners and decision-makers.MethodsA facility -based retrospective cohort study was conducted among 488 severe acute malnourished under-five children admitted from the 1st of January 2016 to the 30th of December 2019. The study participants were selected by using simple random sampling technique. Data were entered in to Epi-Data version 3.1 and exported to STATA version15 statistical software for further analysis. The Kaplan Meier was used to estimate cumulative survival probability and a log-rank test was used to compare the survival time between different categories of explanatory variables. The Cox-proportional hazard regression model was fitted to identify predictors of mortality. P-value< 0.05 was used to declare statistical significance.ResultsOut of the total 488 randomly selected charts of children with severe acute malnutrition, 476 records were included in the final analysis. A total of 54(11.34%) children died with an incidence rate of 9.1death /1000 person- days. Failed appetite test (AHR: 2.4; 95%CI: 1.26, 4.67), altered consciousness level at admission (AHR: 2.4; 95%CI: 1.08, 4.67), oxygen saturation below 90% (AHR: 3.3; 95%CI: 1.40, 7.87), edema (AHR 2.9; 95%CI: 1.45, 5.66) and HIV infection (AHR: 2.8; 95%CI: 1.24, 6.36) were predictors of mortality for children diagnosed with severe acute malnutrition.ConclusionThe overall survival status of severe acute malnourished children was low as compared to national sphere standards and previous reports in the literature. The major predictors of mortality were oxygen saturation below 90%, altered consciousness, HIV infection, edema and failed appetite test. Therefore, early screening of complications, close follow up and regular monitoring of sever acute malnourished children might improve child survival rate.

Determinants of exclusive breastfeeding and overall duration of breastfeeding among mothers in Plateau, Nigeria

Background It is recommended that infants should be fed exclusively with breast milk for the first 6 months, and up to 2 years after birth. This has the potential to improve child survival in limited resource settings. The aim of this study was to identify determinants of exclusive breastfeeding and overall duration of breastfeeding among pregnant mothers in Plateau, Nigeria. Method This was a cross-sectional study involving 763 pregnant mothers attending antenatal clinics in the three senatorial districts of Plateau state, who completed a validated questionnaire. Informed consent was obtained, and all women participated voluntarily. Data were coded and analysed using Chi-square tests and logistic regression, with P&lt;0.05 considered significant. Results Overall, 84.4% of mothers were exclusively breastfeeding at discharge or 48 hours after birth. Exclusive breastfeeding for 6 months was practiced by 36.2% of respondents. Exclusive breastfeeding rates showed a decline as infant age increased. Women with fewer than five children were 2.3 times more likely to feed their baby other foods within the first 6 months than those with five or more children (P=0.001). The average overall duration of breastfeeding was 15 (standard deviation±4) months. Women less than 30 years old were 2.4 times more likely to breastfeed for a shorter period of time, compared to women who were 30 years or older (P&lt;0.001). Chi-square analysis suggested a significant relationship between place of delivery, type of delivery, parity and infant feeding practices. Conclusions Exclusive breastfeeding was not common among the women who participated in this study and declined with increased infant age. The overall duration of breastfeeding was 15 months, which is less than the recommended 2 years. Maternal age, place of delivery, type of delivery and parity were found to influence exclusive breastfeeding and overall breastfeeding. Understanding current practices and factors that influence breastfeeding is important to implement strategies that will empower mothers to breastfeed exclusively. Identifying the cultural practices that act as barriers to early breastfeeding is necessary for the drafting of future interventions to promote breastfeeding.

Subnational estimates of factors associated with under-five mortality in Kenya: a spatio-temporal analysis, 1993–2014

BackgroundTo improve child survival, it is necessary to describe and understand the spatial and temporal variation of factors associated with child survival beyond national aggregates, anchored at decentralised health planning...

Factors Influencing Sustained Utilization of Child Welfare Services among Children Aged 18 to 59 Months in a Low-Income Rural Community, Ghana.

Background Despite substantial progress in reducing child mortality, concerted efforts remain necessary to avoid preventable deaths in children under-5 years and to accelerate progress in improving child survival. The patronage of child welfare services is paramount to the attainment of these goals. This study identified the factors that influence the patronage of child welfare services in a rural community in the Ho West District of the Volta region. Methodology. This quantitative descriptive cross-sectional design employed a systematic sampling method to select 310 caregivers of children aged 18 to 59 months in the Abutia Kloe subdistrict using a pretested questionnaire. The data were entered into a Microsoft excel spreadsheet and cleaned and exported to Statistical Package for Social Sciences (SPSS 22) for analysis. Results The results showed that children (44.2%) had defaulted at a point during the continued growth monitoring process. The reasons for the default included completed major immunization (72.3%), started school (57.4%), and poor staff attitude (3.2%). Mothers have an idea about the purpose of the growth chart (68.0%) as the mothers (86.5%) are able to access a child welfare clinic in less than thirty minutes' walk from their homes. The cross tabulation on level of education and regular CWC attendance showed a strong association (r2 = 8.071, p ≤ 0.03). Cross tabulation on marital status and CWC attendance showed a positive significant association (r2 = 17.307, df = 2, p ≤ 0.001). Married caregivers (85.2%) as compared with unmarried ones (60.5%) are more likely to seek child welfare services for their child. Conclusion Healthcare providers should intensify education on the need to continue growth monitoring up to 59 months even after the completion of major immunization. This goal can be attained if growth monitoring is incorporated into school health activities while policy implementers ensure the full execution.

The Implementation of Infant and Young Children Feeding Counseling

BACKGROUND: Counseling is an important part of successful infant and young child feeding (IYCF). Optimal IYCF is a key area for improving child survival and promoting healthy growth and development. AIM: The purpose of this study is to determine the characteristics and to provide an overview of the input, process, and output components of IYCF counseling in the Central Sulawesi stunting area. MATERIALS AND METHODS: This type of research is a semi-quantitative study which describes the knowledge and abilities of counselors. The population in this study were nutrition officers, midwives, and cadres who had received IYCF training and had followed the orientation of the IYCF module for at least 30 h in stunting focus locations. The sample in the study was counselors who received training in three subdistricts of Central of Sulawesi. RESULTS: The informants were 14 IYCF counselors. All respondents were female, aged 22–48 years. The method of counseling is by the counselor visiting pregnant women/mothers of toddlers/caregivers directly and face to face. In general, inadequate counseling room facilities are the barrier faced by counselors. Training was only limited to orientation and there was no post-training monitoring. The activities carried out by the counselor are in the range of 70–86%. Benefit of giving counseling for IYCF is that mothers will know nutritional status of their children. IYCF increases knowledge about breastfeeding better than milk formulas, the right type and age of feeding. The training has referred to the module referring to the WHO/UNICEF module which is presented in 37 h of field lessons. CONCLUSIONS: Counseling is an important part of successful IYCF. The method of counseling is by the counselor visiting pregnant women/mothers of toddlers/caregivers directly and face to face. Benefit of giving counseling for IYCF is that mothers will know nutritional status of their children.

Patterns and trends in causes of child and adolescent mortality 2000–2016: setting the scene for child health redesign

The under-5 mortality rate has declined from 93 deaths per 1000 live births in 1990 to 39 per 1000 live births in 2018. This improvement in child survival warrants an...

Modeling the cost-effectiveness of point-of-care platforms for infant diagnosis of HIV in sub-Saharan African countries.

Early infant diagnosis of HIV (EID) improves child survival through earlier initiation of antiretroviral therapy (ART). In many settings, ART initiation is hindered by delays in testing performed in centralized labs. Point-of-care (PoC) platforms offer opportunities to improve the timeliness of ART initiation. We used a mathematical model to estimate the costs and performance of on-site PoC testing using three platforms (m-PIMA, GeneXpert IV, and GeneXpert Edge) compared with the standard of care (SoC). Primary outcomes included ART initiation within 60 days of sample collection, HIV-related mortality before ART initiation, and incremental cost-effectiveness ratios (ICERs). PoC testing significantly increased ART initiation within 60 days (from 19% with SoC to 82-84% with PoC) and decreased HIV-related mortality (from 23% with SoC to 5% with PoC). ART initiation and mortality were similar across PoC platforms. When only used for EID and with high coverage of prevention of mother-to-child transmission (PMTCT) programs, ICERs for PoC testing compared with the SoC ranged from $430 to $1097 per additional infant on ART within 60 days and from $1527 to $3888 per death averted. PoC-based testing was more cost-effective in settings with lower PMTCT coverage, greater delays in the SoC, and when PoC instruments could be integrated with other disease programs. Our findings illustrate that PoC platforms can dramatically improve the timeliness of EID and linkage to HIV care. The cost-effectiveness of PoC platforms depends on the cost of PoC testing, existing access to diagnostic testing, and the ability to integrate PoC testing with non-EID programs.

The impact of antenatal care on under\u2010five mortality in Ethiopia: a difference\u2010in\u2010differences analysis

BackgroundSub-Saharan Africa, as opposed to other regions, has the highest under-five mortality rates yet makes the least improvement in reducing under-five mortality. Despite the decline, Ethiopia is among the top ten countries contributing the most to global under-five mortalities. This article examines the impact of the number of antenatal care and the timing of first antenatal care on child health outcomes. We specifically investigated if the utilization of antenatal care services positively affects the reduction of under-five mortality.MethodsWe employ a difference-in-differences design with propensity score matching to identify direct causal effects of antenatal care on under-five mortality based on the Ethiopian Demographic Health Survey data of 2011 and 2016. Our sample includes 22 295 women between the ages of 14–49 who had antenatal care visits at different times before delivery.ResultsThe study revealed 1 481 cases of reported under-five mortality. 99.0% of that under-five mortality cases are women who had less than eight antenatal care visits, while only 1% of that is by women who had eight or more antenatal care visits. Antenatal care visit decreases the likelihood of under-five mortality in Ethiopia by 45.2% (CI = 19.2–71.3%, P-value < 0.001) while the timing of first antenatal care within the first trimester decreases the likelihood of under-five mortality by 10% (CI = 5.7–15.6%, P-value < 0.001).ConclusionsTo achieve a significant reduction in the under-five mortality rate, Intervention programs that encourages more antenatal care visits should be considered. This will improve child survival and help in attaining Sustainable Development Goal targets.