Improve Child Survival Research Articles

Under-5, infant, and neonatal mortality trends and causes of death, 1991–2022: Findings from death surveillance in Xicheng district of Beijing, China

Overall, China has made substantial progress in improving child survival over the past few decades, but a detailed understanding of child mortality trend at local level is limited. This study aimed to present a comprehensive analysis of under-5, infant, and neonatal mortality rates and its trend in Xicheng district of Beijing, China. We used the surveillance data of under-5 children reported by Preventive Health Department of Xicheng District Community Health Service Center from 1991 to 2022. The data was collected based on the Child Death Reporting Card of the Beijing Under-5 Mortality Rate Surveillance Network. Data check was performed by each community health service center and related medical institutions. We extracted data included maternal age, date of death, date of birth, gender, census register, classification of any causes of death, and utilization of healthcare services before death and doubly input it in the Excel 2016 program. Categorization of the causes of death was adapted by the International Categorization of Diseases (ICD-10). Mortality rates and distribution of the leading causes of death were analyzed with descriptive statistics and the Pearson’s Chi-square test using SAS 14.0 software. The Chi-square trend test was used to explore the trends in mortality. Interrupted time series analysis (ITSA) was conducted to assess the impact of the two-child policy on mortality using STATA statistical packages. From 1991 to 2022, totally, there were 166,061 live births and 793 (4.78 ‰) under-5 deaths. The mortality rates of under-5 children, infants and neonates in Xicheng district decreased from 14.75 ‰, 11.25 ‰ and 8.00 ‰ to 1.03 ‰, 0.83 ‰ and 0.41 ‰ respectively. All mortality rates showed an overall significant decline trend (χ2 trend for neonatal = -15.8136, P trend for neonatal < 0.001; χ2 trend for infant = -17.6652, P trend for infant < 0.001; χ2 trend for under-5 = -18.9103, P trend for under-5 < 0.001). The leading causes of death among under-5 children were congenital heart disease (1.65 ‰), birth asphyxia (1.44 ‰), and other congenital abnormalities (except congenital heart disease and down's syndrome) (1.36 ‰). ITSA results showed that the two-child policy did not change the overall decreased trend of child mortality rates. Future preventive measures for child healthcare should give a priority for congenital heart disease, birth asphyxia, and other congenital abnormalities.

Association between mass media exposure and infant and young child feeding practices in India: a cross-sectional study

The first two years of life is a critical window for good nutrition. Promoting infant and young child feeding (IYCF) practices in the first two years can help improve child survival and promote healthy growth and development. Assessment of IYCF practices is important, especially in developing countries like India where optimal IYCF practices can potentially prevent 12% of all deaths under 5 years of age, to promote awareness and intervene appropriately. The objective of our study is to generate evidence for the association between different types of mass media and appropriate IYCF practices in India, including optimal breastfeeding and appropriate complementary feeding practices. A positive association between them can point to intervention at scale. We analyzed data from India’s National Family Health Survey 5 (NFHS-5), 2019–2021. Multivariable logistic regression was used to examine the association of appropriate IYCF practices with mass media exposure. After controlling for demographics and socioeconomic status, the analyses showed that, overall, women who had exposure to television followed by newspaper and movies, had higher odds of adopting the recommended IYCF practices. The results also showed that the association of media exposure varied for different IYCF practices by geography. For instance, in the rural areas, television exposure was positively associated with all the IYCF practices, but in the urban areas, television exposure was positively associated with only early initiation of breastfeeding [OR 1.25; (95% CI 1.1–1.42)]. The study strengthens our understanding that an appropriate selection of mass media channels for intervention programs can promote IYCF practices at scale. Appropriately selecting the type of mass media to create awareness about different IYCF practices, in specific urban–rural settings, could help customize intervention programs to successfully influence IYCF behaviors.

What factors are associated with paediatric admissions and their outcomes in a rural hospital in northern Sierra Leone? Insights from a pilot observational study

IntroductionData on the pattern of admissions and causes of child death are crucial in informing priorities for improving child survival. In many health facilities in sub-Saharan Africa, understanding the pattern...

Problems in accessing health care and child survival in 49 low- and middle-income countries

Abstract Background Access to health care remains suboptimal in many LMICs and continues to hinder children's survival. We aimed to systematically assess the association between problems accessing health care (PAHC) and U5M at the global-, regional-, and country level. Methods Data came from the latest Demographic and Health Surveys of 49 LMICs (2013-2021). Child mortality data were available on 721,658 live births born to mothers aged 15-49 years within the five years preceding the survey. Three domains of PAHC were defined for women who identified the following reasons as PAHC for themselves when they are sick: “money needed for treatment” (economic), “distance to health facility” (physical), “getting permission” or “not wanting to go alone” (socio-cultural). Multivariable logistic regression models were used to estimate the association between PAHC (any and by each type) and U5M. Results In our pooled sample, 4.7% of children died before age of five and 58.4% of mothers reported experiencing PAHC (ranging from 43.2% in Europe &amp; Central Asia to 71.0% in Latin America &amp; Caribbean). Economic PAHC was the most prevalent (42.7%), followed by physical (36.9%) and socio-cultural (35.2%). After adjusting for a comprehensive set of covariates, children of mothers with any PAHC had higher odds of U5M (OR: 1.05, 95% CI: 1.01, 1.08), and this association was especially significant in Sub-Saharan Africa. Of the different domains of PAHC, socio-cultural PAHC was found to have the strongest association with U5M. Conclusions Our findings suggest the need to improve access to health care in LMICs by expanding health care coverage, building health facilities, and focusing more on context-specific socio-cultural barriers to encompass marginalised populations. Key messages • More than half of mothers in low-and middle-income countries had problems accessing health care, and it was associated with increased risk of under-five mortality in children. • To improve child survival in low-and middle-income countries, economic, physical, and socio-cultural barriers to health care should be improved.

E-IMNCI: a novel clinical diagnostic support system approach to strengthen effectiveness and quality of IMNCI implementation in India

Integrated management of childhood illness is a globally proven primary care strategy to improve child survival and is being implemented worldwide in countries with high burden of child mortality. Its...

Unintentional injuries in children in the south of Iran, 2004–2019: a trend analysis of mortality rates

IntroductionInjury is one of the main causes of death and disability in the world. This study was designed to determine the trend of mortality rate and years of life lost...

Impact of essential newborn care education on knowledge and practice of new-born care among nurses in rural primary health centres in Ebonyi state of Nigeria

Background: This study was designed to determine the level of knowledge and the extent of practice of the components of essential new-born care (ENC), and the effects of a training programme on the knowledge and practice of ENC among nurses in rural primary health cares (PHCs) in Ebonyi state Nigeria. Methods: This study was a one group pre-test and post-test intervention design. The components of ENC considered were: New-born initiation of breastfeeding, thermoregulation, new-born cord care, newborn eye care, initiation of breathing and administration of vitamin K. A neonatal care knowledge and practice assessment (NCKPA) questionnaire tested for validity and reliability, with a Spearman’s correlation coefficient of 0.81, was used for data collection among the (48) available nurses (All female). Results: There was significant improvement in the level of knowledge and extent of practice of the components of ENC following the training programme. Despite the improvement, there were gaps in knowledge and practice of the components of ENC amongst the nurses in rural PHCs and affected were the level of knowledge of eye care 20 (41.6%) pre-intervention, and least knowledge of cord care 35 (72.9%) and eye care 45 (93.8%)-post-intervention. Conclusions: Increase in knowledge corresponded with increase in good practice of ENC. The concern with knowledge transfer and translation of knowledge into practice could be achieved by pre-service and in-service education, update courses and workshops, and this will empower the nurses, getting them familiar with current trends and practices for improved child survival rate.

Changes in immunization coverage and contributing factors among children aged 12-23 months from 2000 to 2019, Ethiopia: Multivariate decomposition analysis.

Immunization has been promoted as a global strategy aimed at improving child survival. The World Health Organization strives to make immunization services available to everyone, everywhere to save over 50 million lives by 2030. Monitoring the change and identifying the factors contributing to the change in immunization coverage over time and across the nations is imperative for continuing global success in increasing immunization coverage. In this study, we examined the changes and factors that contributed to the change in full immunization coverage over time in Ethiopia (2000 to 2019). We analyzed data on children aged 12-23 months, extracted from the 2000 and 2019 Ethiopian Demographic and Health Survey (EDHS) datasets. A total of 3,072 weighted samples (2,076 in 2000 and 966 in 2019) were included in the analysis. A multivariate decomposition analysis technique was used to determine change and identify factors that contributed to the change over time. Statistical significance was defined at a 95% confidence interval with a p-value of less than 0.05. There was a 29.56% (95% CI: 24.84, 34.28) change in full immunization coverage between the two surveys. It increased from 14.62% (95% CI: 12.43, 17.11) in 2000 to 44.18% (95% CI: 37.19, 51.41) in 2019. The decomposition analysis showed that about 75% of explained change was attributed to the differences in the composition of explanatory variables (the endowment effect). Particularly, women aged 35-49 years (-2.11%), those who attended four or more antenatal care visits (17.06%), individual who had postnatal care visits (16.90%), households with two or more under-five children (2.50%), and those with a history of child mortality (17.80%) were significantly attributed to the change. The rest, 25% of the explained change was attributed to the difference in the effects of explanatory variables (coefficient). The change in the coefficient for women who had experienced child death (-20.40%) was statistically significant to the change in full immunization coverage over time. The finding of this study revealed that there was a statistically significant change in full immunization coverage over time. The majority of the change was attributed to the differences in the composition of explanatory variables such as antenatal care and postnatal care visits, age of the mother, and number of living children in the household. Therefore, strengthening maternal health services utilization may enhance immunization coverage in Ethiopia. Furthermore, the difference in coefficient of mothers with a history of child death had a substantial counteracting effect on the change, emphasizing the importance of raising awareness and delivering vaccine education to them and the larger community.

Prenatal Intravenous Magnesium at 30-34 Weeks’ Gestation and Neurodevelopmental Outcomes in Offspring

Intravenous magnesium sulfate administered to pregnant individuals before birth at less than 30 weeks' gestation reduces the risk of death and cerebral palsy in their children. The effects at later gestational ages are unclear. To determine whether administration of magnesium sulfate at 30 to 34 weeks' gestation reduces death or cerebral palsy at 2 years. This randomized clinical trial enrolled pregnant individuals expected to deliver at 30 to 34 weeks' gestation and was conducted at 24 Australian and New Zealand hospitals between January 2012 and April 2018. Intravenous magnesium sulfate (4 g) was compared with placebo. The primary outcome was death (stillbirth, death of a live-born infant before hospital discharge, or death after hospital discharge before 2 years' corrected age) or cerebral palsy (loss of motor function and abnormalities of muscle tone and power assessed by a pediatrician) at 2 years' corrected age. There were 36 secondary outcomes that assessed the health of the pregnant individual, infant, and child. Of the 1433 pregnant individuals enrolled (mean age, 30.6 [SD, 6.6] years; 46 [3.2%] self-identified as Aboriginal or Torres Strait Islander, 237 [16.5%] as Asian, 82 [5.7%] as Māori, 61 [4.3%] as Pacific, and 966 [67.4%] as White) and their 1679 infants, 1365 (81%) offspring (691 in the magnesium group and 674 in the placebo group) were included in the primary outcome analysis. Death or cerebral palsy at 2 years' corrected age was not significantly different between the magnesium and placebo groups (3.3% [23 of 691 children] vs 2.7% [18 of 674 children], respectively; risk difference, 0.61% [95% CI, -1.27% to 2.50%]; adjusted relative risk [RR], 1.19 [95% CI, 0.65 to 2.18]). Components of the primary outcome did not differ between groups. Neonates in the magnesium group were less likely to have respiratory distress syndrome vs the placebo group (34% [294 of 858] vs 41% [334 of 821], respectively; adjusted RR, 0.85 [95% CI, 0.76 to 0.95]) and chronic lung disease (5.6% [48 of 858] vs 8.2% [67 of 821]; adjusted RR, 0.69 [95% CI, 0.48 to 0.99]) during the birth hospitalization. No serious adverse events occurred; however, adverse events were more likely in pregnant individuals who received magnesium vs placebo (77% [531 of 690] vs 20% [136 of 667], respectively; adjusted RR, 3.76 [95% CI, 3.22 to 4.39]). Fewer pregnant individuals in the magnesium group had a cesarean delivery vs the placebo group (56% [406 of 729] vs 61% [427 of 704], respectively; adjusted RR, 0.91 [95% CI, 0.84 to 0.99]), although more in the magnesium group had a major postpartum hemorrhage (3.4% [25 of 729] vs 1.7% [12 of 704] in the placebo group; adjusted RR, 1.98 [95% CI, 1.01 to 3.91]). Administration of intravenous magnesium sulfate prior to preterm birth at 30 to 34 weeks' gestation did not improve child survival free of cerebral palsy at 2 years, although the study had limited power to detect small between-group differences. anzctr.org.au Identifier: ACTRN12611000491965.

Predictive Model and Risk Factors of Under-five Mortality in Nigeria: A Study Based on 2018 Nigeria Demographic and Health Survey

The death of children under-five years is one of the critical issues in public health and the need for improving child survival continues to be a matter of urgent concern. In this study, we develop a predictive model in order to examine the risk factors of under-five mortality in Nigeria. The study utilized data from 2018 Nigeria Demographic and Health survey. The demographic and mortality data of 127,545 children were extracted and univariate and multivariate logistic regression models were employed. The results revealed that under-five mortality was 143 deaths per 1,000 live births in Nigeria. The likelihood of death was higher among males compared to females children (OR = 1.893, P&lt;0.05). First and second birth order have a lower chances of decreasing odds of under-five children (OR = 0.737, P&lt;0.05) and (OR = 1.888, P&lt;0.05).The under-five mortality was higher among children born to mothers who belong to other religions compared to Christians. Islam (OR = 1.689, P&lt;0.05) and traditionalist (OR = 2.705, P&lt;0.05) respectively. Public servant (OR = 1.881, P&lt;0.05) and unmarried mother (OR = 1.896, P&lt;0.05) were increased the odds of dying chances of under-five mortality in Nigeria. Children of mothers without education experienced more death compared to mothers who attended post-secondary education (OR = 3.372, P&lt;0.05). Sex of child, birth order, religion, marital status, maternal occupation and maternal education were significant factors associated with under-five mortality in Nigeria. Thus, planning and implementing relevant strategies that focus on those identified risks factors of under-five mortality is required for improvement of child survival in Nigeria.

Education of nurses in rural primary health cares to improve vital care of newborns: A community-based research in Nigeria

This study was designed to ascertain the level of knowledge and the degree of practice of the components of Essential New-born care (ENC), and the effects of a training programme on the knowledge and practice of ENC among nurses in rural Primary Health Cares (PHCs) in South East Nigeria. This study was a one group pre-test and post-test intervention design. The components of ENC considered were: New-Born Initiation of Breastfeeding, Thermoregulation, New-Born Cord Care, Newborn Eye Care, Initiation of Breathing and Administration of Vitamin K. A Neonatal care Knowledge and Practice Assessment (NCKPA) Questionnaire tested for validity and reliability, with a Spearman’s correlation coefficient of 0.81, was used for data collection among the (96) available nurses (All female). There was significant improvement in the level of knowledge and extent of practice of the components of ENC following the training programme. Despite the improvement, there were gaps in knowledge and practice of the components of ENC amongst the nurses in rural PHCs and affected were the level of knowledge of Eye care 40(41.6%) - pre-intervention, and least knowledge of cord care 70 (72.9%) and eye care 90(93.8%) - post-intervention. Increase in knowledge corresponded with increase in good practice of ENC. The concern with knowledge transfer and translation of knowledge into practice could be achieved by pre-service and in-service education, update courses and workshops, and this will empower the nurses, getting them familiar with current trends and practices for improved child survival rate.

Causes of Death Among Infants and Children in the Child Health and Mortality Prevention Surveillance (CHAMPS) Network.

The number of deaths of children younger than 5 years has been steadily decreasing worldwide, from more than 17 million annual deaths in the 1970s to an estimated 5.3 million in 2019 (with 2.8 million deaths occurring in those aged 1-59 months [53% of all deaths in children aged <5 years]). More detailed characterization of childhood deaths could inform interventions to improve child survival. To describe causes of postneonatal child deaths across 7 mortality surveillance sentinel sites in Africa and Asia. The Child Health and Mortality Prevention Surveillance (CHAMPS) Network conducts childhood mortality surveillance in sub-Saharan Africa and South Asia using innovative postmortem minimally invasive tissue sampling (MITS). In this cross-sectional study, MITS was conducted in deceased children aged 1 to 59 months at 7 sites in sub-Saharan Africa and South Asia from December 3, 2016, to December 3, 2020. Data analysis was conducted between October and November 2021. The expert panel attributed underlying, intermediate, and immediate conditions in the chain of events leading to death, based on histopathologic analysis, microbiological diagnostics, clinical data, and verbal autopsies. In this study, MITS was performed in 632 deceased children (mean [SD] age at death, 1.3 [0.3] years; 342 [54.1%] male). The 6 most common underlying causes of death were malnutrition (104 [16.5%]), HIV (75 [11.9%]), malaria (71 [11.2%]), congenital birth defects (64 [10.1%]), lower respiratory tract infections (LRTIs; 53 [8.4%]), and diarrheal diseases (46 [7.2%]). When considering immediate causes only, sepsis (191 [36.7%]) and LRTI (129 [24.8%]) were the 2 dominant causes. An infection was present in the causal chain in 549 of 632 deaths (86.9%); pathogens most frequently contributing to infectious deaths included Klebsiella pneumoniae (155 of 549 infectious deaths [28.2%]; 127 [81.9%] considered nosocomial), Plasmodium falciparum (122 of 549 [22.2%]), and Streptococcus pneumoniae (109 of 549 [19.9%]). Other organisms, such as cytomegalovirus (57 [10.4%]) and Acinetobacter baumannii (39 [7.1%]; 35 of 39 [89.7%] considered nosocomial), also played important roles. For the top underlying causes of death, the median number of conditions in the chain of events leading to death was 3 for malnutrition, 3 for HIV, 1 for malaria, 3 for congenital birth defects, and 1 for LRTI. Expert panels considered 494 of 632 deaths (78.2%) preventable and 26 of 632 deaths (4.1%) preventable under certain conditions. In this cross-sectional study investigating causes of child mortality in the CHAMPS Network, results indicate that, in these high-mortality settings, infectious diseases continue to cause most deaths in infants and children, often in conjunction with malnutrition. These results also highlight opportunities for action to prevent deaths and reveal common interaction of various causes in the path toward death.

High burden of clinically significant adverse events associated with contemporary therapy for pediatric T-cell acute lymphoblastic leukemia/lymphoma.

Despite improvements in survival for children with T-cell acute lymphoblastic leukemia and lymphoma (T-ALL/LLy), morbidity remains high. However, data are lacking regarding comprehensive descriptions of clinically relevant adverse events (AEs) experienced during early intensive chemotherapy. This single-institution retrospective study evaluated children aged 1-21 years with T-ALL/T-LLy diagnosed from 2010 to 2020. Physician chart abstraction identified and graded 20 clinically relevant AEs. AE rates were analyzed by T-ALL or LLy, minimal residual disease status, induction steroid, and use of antimicrobial prophylaxis. Statistical comparisons used the Kruskal-Wallis test (continuous variables) and Chi-square or Fisher's exact test (categorical variables). The cohort included 120 patients (T-ALL: 88; T-LLy: 32). Most patients experienced AEs during induction (85 out of 120; 70.8%) and consolidation (89 out of 111; 80.2%). Nonsepsis infection was common in induction (26 out of 120; 21.7%) and consolidation (35 out of 111; 31.5%). Patients treated with dexamethasone during induction had significantly higher rates of nonsepsis infection and/or sepsis during consolidation than those who received prednisone (p<.01). Clinically significant AEs are extremely common during induction and consolidation therapy for patients with T-ALL/LLy. Infectious AEs are particularly prevalent. These results can inform conversations with patients and families and aid in the development of toxicity-related aims in the next generation of, prospective clinical trials in T-ALL/LLy.

Analysis of Gender Disparity in Economic Growth of Third World Economy

This article focuses on the gender gap in economic growth across the third world. It has been noted in the past that women’s labour is never viewed as being on par with men’s labour. Promoting a stronger role for women helps the economy, improves child survival and family health, and decreases reproduction, reducing population growth rates, according to global experience. In other words, egalitarianism is vital for long-term prosperity. In every country, women make up half of the population. We need to consider how women contribute to a nation’s economic development. According to the United Nations (1993), they only receive a modest percentage of chances and advantages. Women’s empowerment will directly impact economic diversification, increased productivity, and income equality, all of which will lead to other beneficial development outcomes. In this paper, emphasis has been put up on the comparative understanding of developed and developing nations. Additionally, a broad comparison is made for both nations. Some instances are also mentioned where women have contributed significantly to global economic progress.

Impact of kinship support on child mortality in the Upper East Region of Ghana: assessing the Grandmother Hypothesis.

The grandmother is an important kin member whose contribution to childcare and survival has been recognized in the literature, hence the Grandmother Hypothesis. This article examines the effect of the presence of a grandmother on child mortality. Data were obtained from the Navrongo Health and Demographic Surveillance System, located in the Upper East Region of Ghana. Children born between January 1999 and December 2018 were included in the analysis. Person-months lived for each child were generated. The multilevel Poisson regression technique was employed to investigate the effect of a grandmother on child survival. In all, 57116 children were included in the analysis, of which 7% died before age 5y. Person-months were generated for the children, which produced 2.7 million records, with about 487800 person-years. After controlling for confounders, results showed that children in households with paternal grandmothers are 11% less likely to die compared with those without paternal grandmothers. However, when other confounders were taken into accounts, the beneficial effect of maternal grandmothers disappeared. We conclude that the presence of grandmothers improves child survival, thus sustaining the Grandmother Hypothesis. The experiences of these grandmothers should be tapped to improve child survival, particularly in rural areas.

Estimating the impact of birth interval on under-five mortality in east african countries: a propensity score matching analysis

BackgroundUnder-five mortality remains a global public health concern, particularly in East African countries. Short birth interval is highly associated with under-five mortality, and birth spacing has a significant effect on a child’s likelihood of survival. The association between short birth intervals and under-five mortality was demonstrated by numerous observational studies. However, the effect of short birth intervals on under-five mortality has not been investigated yet. Therefore, this study aimed to investigate the impact of short birth intervals on under-five mortality in East Africa using Propensity Matched Analysis.MethodsA secondary data analysis was conducted based on the most recent Demographic and Health Survey (DHS) data of 12 East African countries. A total weighted sample of 105,662 live births was considered for this study. A PSM analysis was carried out to evaluate the effect of short birth intervals on under-five mortality. Under-five mortality was the outcome variable, while the short birth interval was considered a treatment variable. To determine the Average Treatment Effect on the population (ATE), Average Treatment Effect on the treated (ATT), and Average Treatment Effect on the untreated (ATU), we performed PSM analysis with a logit-based model using the psmatch2 ate STATA function. The quality of matching was assessed statistically and graphically. The common support assumption was checked and fulfilled. We have employed Mantel-Haenszel bounds to examine whether the result would be free from hidden bias or not.ResultsThe prevalence of short birth intervals in East Africa was 44%. The under-five mortality rate among mothers who had optimal birth intervals was 39.9 (95% CI: 38.3, 41.5) per 1000 live births while it was 60.6 (95% CI: 58.5, 62.8) per 1000 live births among mothers who had a short birth intervals. Propensity score matching split births from mothers into treatment and control groups based on the preceding birth interval. In the PSM analysis, the ATT values in the treated and control groups were 6.09% and 3.97%, respectively, showed under-five mortality among births to mothers with short birth intervals was 2.17% higher than births to mothers who had an optimal birth interval. The ATU values in the intervention and control groups were 3.90% and 6.06%, respectively, indicating that for births from women who had an optimal birth interval, the chance of dying within five years would increase by 2.17% if they were born to mother with short birth interval. The final ATE estimate was 2.14% among the population. After matching, there was no significant difference in baseline characteristics between the treated and control groups (p-value > 0.05), which indicates the quality of matching was good.ConclusionsWe conclude that enhancing mothers to have optimal birth spacing is likely to be an effective approach to reducing the incidence of under-five mortality. Our findings suggest that births to mothers with short birth intervals have an increased risk of death in the first five years of life than births to mothers who had an optimal birth interval. Therefore, public health programs should enhance interventions targeting improving birth spacing to reduce the incidence of under-five mortality in low-and middle-income countries like East African countries. Moreover, to achieve a significant reduction in the under-five mortality rate, interventions that encourage birth spacing should be considered. This will improve child survival and help in attaining Sustainable Development Goal targets in East African countries.

Exploring the most dominant drivers of inequalities in child survival in Ethiopia: Dominance analysis

Inequalities in child survival are a global public health concern. Over the past decade, Ethiopia has made remarkable progress in improving child survival. Despite this promising development, inequalities in child survival among the various population groups remained a pressing public health concern. The purpose of this paper is to examine the dominant drivers of inequality in child survival indicators (undernutrition, anemia, and under-five mortality) in Ethiopia. Dominance analysis was used based on a pooled total sample of 48,422 under-five children drawn from five rounds of Ethiopia Demographic and Health Surveys conducted from year 2000 to 2019. Childhood undernutrition, childhood anemia, and under-five mortality were the three outcome variables, and the five dimensions of inequality were considered as key predictor variables. The dominance analysis revealed that maternal education, place of residence, and household wealth index were the three most dominant drivers of inequalities in childhood undernutrition, accounting for 83.48% of the predicted variances. The regional category was found to be the first-ranked key driver of inequalities in childhood anemia, accounting for 50.56% of the predicted variance. The dominance analysis also indicated that maternal education, child sex, and place of residence were the three most dominant drivers of inequality in under-five mortality, accounting for 89.3% of the predicted variance. This study provides empirical evidence that maternal education (individual level), household asset based wealth index (household level), and place of residence (community level) were the most dominant drivers of inequality in child survival. This suggests interventions in reducing inequalities in child survival need to start at the community level, notwithstanding the importance of household and individual level influences.

How Zambia reduced inequalities in under-five mortality rates over the last two decades: a mixed-methods study

BackgroundZambia experienced a major decline in under-five mortality rates (U5MR), with one of the fastest declines in socio-economic disparities in sub-Saharan Africa in the last two decades. We aimed to understand the extent to which, and how, Zambia has reduced socio-economic inequalities in U5MR since 2000.MethodsUsing nationally-representative data from Zambia Demographic Health Surveys (2001/2, 2007, 2013/14 and 2018), we examined trends and levels of inequalities in under-five mortality, intervention coverage, household water and sanitation, and fertility. This analysis was integrated with an in-depth review of key policy and program documents relevant to improving child survival in Zambia between 1990 and 2020.ResultsThe under-five mortality rate (U5MR) declined from 168 to 64 deaths per 1000 live births between 2001/2 and 2018 ZDHS rounds, particularly in the post-neonatal period. There were major reductions in U5MR inequalities between wealth, education and urban–rural residence groups. Yet reduced gaps between wealth groups in estimated absolute income or education levels did not simultaneously occur. Inequalities reduced markedly for coverage of reproductive, maternal, newborn and child health (RMNCH), malaria and human immunodeficiency virus interventions, but less so for water or sanitation and fertility levels.Several policy and health systems drivers were identified for reducing RMNCH inequalities: policy commitment to equity in RMNCH; financing with a focus on disadvantaged groups; multisectoral partnerships and horizontal programming; expansion of infrastructure and human resources for health; and involvement of community stakeholders and service providers.ConclusionZambia’s major progress in reducing inequalities in child survival between the poorest and richest people appeared to be notably driven by government policies and programs that centrally valued equity, despite ongoing gaps in absolute income and education levels. Future work should focus on sustaining these gains, while targeting families that have been left behind to achieve the sustainable development goal targets.

Women’s Fertility and Labor Market Responses to a Health Innovation

Abstract We investigate women’s fertility, labor, and marriage market responses to a health innovation that led to reductions in mortality from treatable causes, and especially large declines in child mortality. We find delayed childbearing, with lower intensive and extensive margin fertility, a decline in the chances of ever having married, increased labor force participation, and an improvement in occupational status. Our results provide the first evidence that improvements in child survival allow women to start fertility later and invest more in the labor market. We present a new theory of fertility that incorporates dynamic choices and reconciles our findings with existing models of behavior.

Child Health and Mortality Prevention Surveillance (CHAMPS): Manhiça site description, Mozambique.

The Manhiça Health Research Centre (Manhiça HDSS) was established in 1996 in Manhiça, a rural district at Maputo Province in the southern part of Mozambique with approximately 49,000 inhabited households, a total population of 209.000 individuals, and an annual estimated birth cohort of about 5000 babies. Since 2016, Manhiça HDSS is implementing the Child Health and Mortality Prevention Surveillance (CHAMPS) program aiming to investigate causes of death (CoD) in stillbirths and children under the age of 5 years using an innovative post-mortem technique known as Minimally Invasive Tissue sampling (MITS), comprehensive pathogen screening using molecular methods, clinical record abstraction and verbal autopsy. Both in-hospital and community pediatric deaths are investigated using MITS. For this, community-wide socio-demographic approaches (notification of community deaths by key informants, formative research involving several segments of the community, availability of free phone lines for notification of medical emergencies and deaths, etc.) are conducted alongside to foster community awareness, involvement and adherence as well as to compute mortality estimates and collect relevant information of health and mortality determinants. The main objective of this paper is to describe the Manhiça Health and Demographic Surveillance System (HDSS) site and the CHAMPS research environment in place including the local capacities among its reference hospital, laboratories, data center and other relevant areas involved in this ambitious surveillance and research project, whose ultimate aim is to improve child survival through public health actions derived from credible estimates and understanding of the major causes of childhood mortality in Mozambique.