Preventable Child Deaths Research Articles

Statistical Trend Analysis on Infant Mortality Rate and Estimation of Live Births in Nigeria

Particularly in nations like Nigeria, the likelihood that a child may pass away before turning one is rather distressing. Infant Mortality Rate is the term used to describe this. Ending all preventable deaths of children under the age of five is goal 3.2 of the Sustainable Development Goals (SDGs). This study's foundation is the statistical analysis of Nigeria's infant mortality rate. The secondary data was gathered from the World Bank Survey, which included annual records of the infant mortality rate in Nigeria over the ten-year period from 2012 to 2021. To assess the trend and estimate the model parameters, Time Series Analysis (TREND) was the statistical method employed. The researchers used the trend to predict for the following ten years. Both the number of infant fatalities and the infant mortality rate are moving decrease, according to the trend study. This demonstrates that the Infant Mortality Rate in Nigeria steadily decreases as the live birth rate rises, yet it is unlikely that it will reach zero or be insignificant by 2032. According to the analysis, the quadratic trend model fits the data sets the best because it has the smallest error margin and an R-square value that is extremely close to 100%. According to the model developed, Nigeria's infant mortality rate is expected to continue to drop throughout the course of the following ten years. Yet, the finding is not striking enough because, in 2031, the infant mortality rate will probably still be higher than 45. Hence, if appropriate measures are not implemented, we will not be able to achieve the goal of eliminating all preventable deaths of children under the age of five and lowering new birth deaths to no more than 12 per thousand. Also, it was seen from the table and graphs that the infant mortality rate decreased more rapidly from 2016 to 2017. This shows that the Sustainable Development Goals (SDGs), which went into effect in 2016, contributed to a decrease in the infant mortality rate.

Child mortality remains a serious public health problem

The identification of factors related to infant deaths can help in the planning of public health actions for the restructuring and improvement of maternal and child care, with a view to reducing infant mortality. The variables related to infant mortality continue to be incident in males, in those of brown color, with birth weight below normal and children of young mothers. Actions with technical and financial investment throughout prenatal care with a complete care network and strengthening childcare services for children by the Primary Care network at municipal level are necessary and urgent strategies to reduce the drama of preventable deaths of children in the first year of life.

Contextual, maternal, and infant factors in preventable infant deaths: a statewide ecological and cross-sectional study in Rio Grande do SUL, Brazil

BackgroundEnding preventable deaths of newborns and children under five by 2030 is among the United Nations Sustainable Development Goals. This study aimed to describe infant mortality rate due to preventable causes in Rio Grande do Sul (RS), the Southernmost state in Brazil. With 11,329,605 inhabitants and 141,568 live births in 2017, RS was the fifth most populous state in the country.MethodAn ecological and cross-sectional statewide study, with data extracted from records of the Mortality Information System, Death Certificates, and Live Birth Certificates for the year 2017. Preventability was estimated by applying the List of Causes of Deaths Preventable through Intervention of SUS (acronym for Sistema Unico de Saude - Brazilian Unified Health System) Intervention. Rates of preventable infant mortality (PIMR), preventable early neonatal mortality (PENMR), preventable late neonatal mortality (PLNMR), and preventable post-neonatal mortality (PPNMR) per 1000 live births (LB) were quantified. Incidence ratios, according to contextual characteristics (human development index of the health region and of the municipality; Gini index of the municipality), maternal characteristics at the time of delivery (age, education, self-reported skin color, presence of a partner, number of antenatal care consultations, and type of delivery), and characteristics of the child at the time of birth (gestational age, weight, and pregnancy type) were calculated.ResultsIn 2017, there were 141,568 live births and 1425 deaths of infants younger than 1 year old, of which 1119 were preventable (PIMR = 7.9:1000 LB). The PENMR, PLNMR, and PPNMR were 4.1:1000 LB; 1.5:1000 LB; and 2.3:1000 LB, respectively. More than 60% of deaths in the first week and 57.5% in the late neonatal period could be reduced through adequate care of the woman during pregnancy. The most frequent preventable neonatal causes were related to prematurity, mainly acute respiratory syndrome, and non-specified bacterial septicemia. In the post-neonatal period, 31.8% of deaths could be prevented through adequate diagnostic and treatment.ConclusionsThe strategies needed to reduce preventable infant deaths should preferably focus on preventing prematurity, through adequate care of the woman during pregnancy.

FOOD INFLATION AND CHILD HEALTH IN AFRICA: EVIDENCE FROM COUNTRIES WITH HIGH MISERY INDEX

This paper investigates the effect of food price inflation on the public health improvement as measured in terms of life expectancy, infant mortality rate, under five mortality rate and neonatal mortality rate in six selected African countries with high misery index for the period from 2000 to 2020. The Augmented Mean Group and Common Correlated Estimation Mean Group were used to determine the effect, as well as Westerlund Cointegration tests. Our findings revealed that rising food prices have a significant detrimental effect on nourishment and consequently lead to higher levels of infant under five and neonatal mortality while reducing the expected life expectancy in the African countries. High food price inflation also has a long run effect on public health. The implication of the result shows that with high rate of food prices coupled with poor child health, the Sustainable Development Goals target of ending preventable deaths of newborns and children under age of 5, and the aim of having a neonatal mortality rate of 12 or fewer deaths per 1,000 live births, and an under-five mortality rate of 25 or fewer deaths per 1,000 live births, by 2030 may not be realistic. Therefore, African Governments should gear up efforts towards reducing food price inflation, improving health expenditure, per capita income and enabling environment for safe sanitation, especially for pregnant women and little children. Also, Governments should create enabling environment for sanitation and access to safe drinking water.

A Comparative Study of Infant and Under 5 Mortality Rate and Institutional Births of EAG States with Reference to SDG-3 (Target -2): An Analysis of the NFHS (2019-20)

Children and maternal health are the supreme assets of a nation. Because mothers are reproductive or fertile women and children are the future of the nation. Therefore, both play a vital role for the future of the nation. The increase in economic productivity depends upon the health of the residents of any area. As we know that in 1980s, the social development indicators were included in the development indicators. The social development indicator includes health, education, sanitation, hygiene, etc.; in which health and education play a vital role in economic development. Sustainable Development has 17 goals in which SDG- Goal- 3 is related to Health and Well-being. SDG-3 have 13 targets and 28 indicators defined by United Nations like MMR, U5MR, IMR, HIV, suicide rates, life expectancy, etc. in which Out of 13 target, this study is based on SDG Goal – 3.2 (By 2030, end of preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce IMR to at least as low as 12 per 1000 live births instead of NNMR and Under -5 mortality to at least as low as 25 per 1000 live births) and Institutional birth of EAG States. The EAG states mainly consist of Uttar Pradesh, Uttarakhand, Bihar, Orissa, Jharkhand, Chhattisgarh, Rajasthan and Madhya Pradesh. This study is focused upon the comparative study among EAG states in terms of Infant and child mortality rate and institutional birth with the help of NFHS.

Practitioner Perspectives on Child Feeding in Uganda: Community Engagement through the Global Agenda

This collaborative research study arose in response to the United Nations Sustainable Development Goals 2 and 3, which have amongst their targets an aim to eradicate preventable deaths in children under five years old. The research is founded on the aims of the Global Agenda for Social Work and Social Development which aims at strengthening the social work profession through linkages between global challenges and local responses. To address these issues through nutritious child feeding, it was essential to understand the views and experiences of SW and social development practitioners involved with child feeding practices. Through an online qualitative survey and reflexive thematic analysis, we explored the views and experiences of practitioners working with the Uganda Red Cross Society. Three themes were developed from analysis of the data: Lifestyle Choices & Restrictions; Limited Resources & Facilities; and Knowledge & Education. A reflection on the challenges encountered and advancing international social work through engagement with the Global Agenda are also presented.

Barriers, facilitators, and implementation strategies for the initiation of Child Death Review system in Japan: a modified Delphi method study

Background:To further curb preventable child deaths, some countries have implemented Child Death Review (CDR). CDR is a comprehensive multidisciplinary process that investigates, reviews, and registers all child deaths to consider prevention strategies. This study deciphered the barriers, facilitators, and implementation strategies in Japan.Methods:This study used a three-round modified Delphi method. The expert panel consisted of local government officers and health professionals responsible for the CDR pilot project in Japan. As a modification, the initial list of barriers, facilitators, and implementation strategies to address each barrier and facilitator was prepared based on project reports and interviews with local government officers. Throughout the three rounds, the panel evaluated predefined barriers and facilitators, suggested and evaluated additional items, and appraised the potential effectiveness of the implementation strategies on barriers and facilitators which they were meant to address. The importance of barriers and facilitators, and the potential effectiveness of implementation strategies were evaluated using 5-point Likert scale. The priority of the combinations of barriers, facilitators, and implementation strategies were determined considering their importance and effectiveness.Results:A total of 31 experts participated in the panel. Response rates were 96.8%, 80.6%, and 90.3% for the first, second, and third rounds, respectively. A total of 13 barriers, eight facilitators, and 72 implementation strategies corresponding to the barriers and facilitators reached consensus. At the national government level, a barrier-strategy combination of “lack of legislation (barrier)” and “legislation for CDR (strategy),” and a facilitator-strategy combination of “good multi-agency collaboration (facilitator)” and “official notices from the national government (strategy)” were at the highest priority. At the local government level, combinations of “lack of legislation (barrier)” and “constant budget allocations (strategy),” “lack of legislation (barrier)” and “citizens’ acceptance (strategy),” and “good multi-agency collaboration (facilitator)” and “appointment of a full-time staff (strategy)” were at the highest priority.Conclusion:This study demonstrated that legislation is the key to better implementation of CDR in Japan. Legislation can address various barriers such as personal information collection, multi-agency collaboration, high workload, and budget instability. Without legislation, careful strategies must be taken to solve difficulties caused by its absence.Trial registrations:None.

Fabrication of Disposable Electrodes Based on Green Synthesized Iron Oxide Nanoparticles for Enumeration of Bacteria in Water

Poor drinking water quality is a leading cause of preventable deaths in young children. Identifying contaminated water is a major challenge, especially where water resources are very limited. There is an urgent need to fabricate smart disposable electrodes to detect specific Escherichia coli ATCC-25922 in water to protect against diseases such as gastroenteritis and acute diarrhea. In this article, we presented a simple method to fabricate disposable electrodes using single-pot green iron oxide nanoparticles. The nanostructure and detailed morphology of the green synthesized iron oxide nanoparticles (Ne-Ne-Fe3O4-NPs) were analyzed using analytical techniques. Modified Ne-Fe3O4-NPs developed the disposable electrode and cyclic voltammetry (CV) was used to detect the target bacteria. Under optimized experimental conditions, the signals increased linearly while the concentration range increased from 101−107 CFU ml−1, having a short response of time 35 min. In addition, the fabricated disposable electrode showed dynamic detection range, stability of the electrode, and selectivity and provides a new strategy by using green nanoparticles to detect selected bacteria from water.

The projections of global and regional rheumatic heart disease burden from 2020 to 2030.

Rheumatic heart disease (RHD) remains the leading cause of preventable death and disability in children and young adults, killing an estimated 320,000 individuals worldwide yearly. We utilized the Bayesian age-period cohort (BAPC) model to project the change in disease burden from 2020 to 2030 using the data from the Global Burden of Disease (GBD) Study 2019. Then we described the projected epidemiological characteristics of RHD by region, sex, and age. The global age-standardized prevalence rate (ASPR) and age-standardized incidence rate (ASIR) of RHD increased from 1990 to 2019, and ASPR will increase to 559.88 per 100,000 population by 2030. The global age-standardized mortality rate (ASMR) of RHD will continue declining, while the projected death cases will increase. Furthermore, ASPR and cases of RHD-associated HF will continue rising, and there will be 2,922,840 heart failure (HF) cases in 2030 globally. Female subjects will still be the dominant population compared to male subjects, and the ASPR of RHD and the ASPR of RHD-associated HF in female subjects will continue to increase from 2020 to 2030. Young people will have the highest ASPR of RHD among all age groups globally, while the elderly will bear a greater death and HF burden. In the following decade, the RHD burden will remain severe. There are large variations in the trend of RHD burden by region, sex, and age. Targeted and effective strategies are needed for the management of RHD, particularly in female subjects and young people in developing regions.

Effectiveness of rectal artesunate as pre-referral treatment for severe malaria in children under 5 years of age: a multi-country observational study

BackgroundTo prevent child deaths from severe malaria, early parenteral treatment is essential. Yet, in remote rural areas, accessing facilities offering parenteral antimalarials may be difficult. A randomised controlled trial found pre-referral treatment with rectal artesunate (RAS) to reduce deaths and disability in children who arrived at a referral facility with delay. This study examined the effectiveness of pre-referral RAS treatment implemented through routine procedures of established community-based health care systems.MethodsAn observational study accompanied the roll-out of RAS in the Democratic Republic of the Congo (DRC), Nigeria and Uganda. Children <5 years of age presenting to a community-based health provider with a positive malaria test and signs of severe malaria were enrolled and followed up during admission and after 28 days to assess their health status and treatment history. The primary outcome was death; covariates of interest included RAS use, referral completion, and post-referral treatment.ResultsPost-roll-out, RAS was administered to 88% of patients in DRC, 52% in Nigeria, and 70% in Uganda. The overall case fatality rate (CFR) was 6.7% (135/2011) in DRC, 11.7% (69/589) in Nigeria, and 0.5% (19/3686) in Uganda; 13.8% (865/6286) of patients were sick on day 28. The CFR was higher after RAS roll-out in Nigeria (16.1 vs. 4.2%) and stable in DRC (6.7 vs. 6.6%) and Uganda (0.7 vs. 0.3%). In DRC and Nigeria, children receiving RAS were more likely to die than those not receiving RAS (aOR=3.06, 95% CI 1.35–6.92 and aOR=2.16, 95% CI 1.11–4.21, respectively). Only in Uganda, RAS users were less likely to be dead or sick at follow-up (aOR=0.60, 95% CI 0.45–0.79). Post-referral parenteral antimalarials plus oral artemisinin-based combination therapy (ACT), a proxy for appropriate post-referral treatment, was protective. However, in referral health facilities, ACT was not consistently administered after parenteral treatment (DRC 68.4%, Nigeria 0%, Uganda 70.9%).ConclusionsImplemented at scale to the recommended target group, pre-referral RAS had no beneficial effect on child survival in three highly malaria-endemic settings. RAS is unlikely to reduce malaria deaths unless health system issues such as referral and quality of care at all levels are addressed.Trial registrationThe study is registered on ClinicalTrials.gov: NCT03568344.

The impact of maternal health insurance coverage and adequate healthcare services utilisation on the risk of under-five mortality in Nigeria: a cross-sectional study

BackgroundDespite the progress in reducing under-five mortality (U-5 M) in recent years, these deaths remain considerably high in Nigeria. This could be attributed to poor health policies including inequality of health insurance coverage and access to adequate healthcare services utilisations which has remained inimical to achieving sustainable development goals (SDGs). Therefore, this study examined the impact of maternal health insurance coverage and adequate healthcare services utilisation on the risk of U-5 M in Nigeria.MethodsThe data for the study were derived from the 2018 Nigeria Demographic and Health Survey and comprised a weighted sample of 127,545 birth histories of childbearing women. Descriptive and analytical analyses were carried out, including frequency tables and multivariate using Cox proportional regression. The results were presented as hazard ratios (HR) with 95% confidence intervals (CIs). Data were analyzed using Stata software version 15.1.ResultsThe results showed that 14.3% of the sampled birth histories of the childbearing women were children who died before age 5. The results further showed that 97.7% of the children were of mothers who have health insurance and over one-half (56.5%) were children whose mothers had adequate healthcare services utilisation. The risk of under-five death was significantly lower among the children of mothers who were covered by health insurance (HR: 0.66, CI: 0.42–1.02) and those whose mothers utilised adequate healthcare services (HR: 0.78, CI: 0.68–0.90). A similar result was observed among children whose mothers reported that distance to the health facility was not a problem (HR: 0.81, CI: 0.72–0.86). Some mothers’ characteristics including educational attainment, wealth quintile and region of residence significantly influenced the risk of U-5 M.ConclusionsThe study established that maternal health insurance coverage and adequate healthcare services utilisation were found to be protective factors against the risk of U-5 M. Also, the revealed low health insurance coverage of mothers calls for more pragmatic policy and intervention programmes through health insurance to achieve SDGs targets of ending preventable deaths of children under 5 years of age and ensuring quality, as well as universal access to maternal and child healthcare services.

Determinants of neonatal mortality in the neonatal intensive care unit of Dilla University Referral Hospital, Southern Ethiopia; 2019–2020; A matched, case–control study

BackgroundNeonatal mortality rate (NMR) refers to the number of deaths occurring from birth to 28 days of life per-1000 Live Births (LB). The global NMR declined from 37 deaths per- 1,000 LB in 1990 to 18 in 2017, whereas it was 27 deaths per 1000 LB in the Sub-Saharan region. Ethiopia plans to reduce the NMR from 28 deaths to 11 deaths per 1,000 LB by 2020 and to end all preventable child deaths by 2035. The aim of this study was to identify the determinants of neonatal mortality in the neonatal intensive care unit (NICU) of Dilla University Referral Hospital (DURH). MethodsAn age-matched case control study was conducted at DURH's NICU. Two controls having age 2 days before or after the case were used for matching. One hundred eighteen cases (died) and 236 controls (survived) neonates admitted to the NICU from January 11, 2018, to February 25, 2020, were studied. Missed data were filled by multiple imputations. Multicollinearity was checked by the variance inflation factor. For variables with a P-value <0.2 on bivariable conditional logistic regression, multivariable conditional logistic regression analysis was performed to control for confounders using clogit command in a survival package to identify the risk factors for neonatal mortality using R version 3.6.3. ResultGestational age <37 weeks (Adjusted matched odds ratio (AmOR): 14.02; 95% confidence interval (CI): 3.68–53.46), first-minute APGAR score <7 (AmOR: 5.68; 95% CI: 1.76–18.31), perinatal asphyxia (PNA) (AmOR: 4.62; 95% CI: 1.15–18.53) and being twins (AmOR: 6.84; 95% CI: 1.34–34.96) were significantly associated with neonatal deaths in our study. Furthermore, antenatal care and follow-up during pregnancy (AmOR: 0.15; 95% CI: 0.04–0.53) and having a normal random blood sugar level at admission (AmOR: 0.1; 95% CI: (0.02–0.66) were found to be determinant of neonatal mortalities in our study. ConclusionGestational age less than 37 weeks, first-minute APGAR scores <7, being twins, diagnosis of PNA, antenatal care and follow-up of mothers during pregnancy and normoglycemia in neonates at admission were significant determinant of neonatal death in the NICU of DURH.

Making every contact count: Can healthcare professionals do more to avoid preventable child deaths?

BackgroundHealthcare professionals (HCPs) have a responsibility and unique opportunities to identify and act on safeguarding concerns. Child Safeguarding Practice Reviews (CSPRs) are produced in the United Kingdom when a child has died or been seriously harmed, and abuse or neglect is suspected or confirmed. To our knowledge there is no recent systematic analysis of CSPRs from an HCP perspective. ObjectiveTo establish if HCPs are acting in an appropriate and safe manner when confronted with cases of potential child abuse and neglect and recommend areas for further improvement. Participants and settingsCSPR abstracts published on a specialist UK database between 2018 and 2021 involving the death of a child. MethodsAfter applying the exclusion criteria we used stratified random sampling to select one third of eligible reports. Using a systematic framework, common qualitative themes were extracted and analyzed. Results42 of 125 eligible CSPRs were analyzed. Child deaths were more common in male children and those aged under one. We identified areas where communication could be further improved including better understanding of the referral process, coordination at discharge, and communication between primary and secondary care. We found that HCPs were not well equipped to identify risk factors for child abuse such as poor parental health and complex family structures. ConclusionsThere is significant scope for improvement in strengthening the knowledge and skill base of HCPs in identifying and acting on signs of child abuse. We propose improvements in terms of staff training, resources and better systems to ensure HCPs respond to safeguarding concerns safely and appropriately.

Defining Surgical Workforce Density Targets to Meet Child and Neonatal Mortality Rate Targets in the Age of the Sustainable Development Goals: A Global Cross-Sectional Study.

To reduce preventable deaths of newborns and children, the United Nations set a target rate per 1000 live births of 12 for neonatal mortality (NMR) and 25 for under-5 mortality (U5MR). The purpose of this paper is to define the minimum surgical workforce needed to meet these targets and evaluate the relative impact of increasing surgeon, anesthesia, and obstetrician (SAO) density on reducing child mortality. We conducted a cross-sectional study of 192 countries to define the association between surgical workforce density and U5MR as well as NMR using unadjusted and adjusted B-spline regression, adjusting for common non-surgical causes of childhood mortality. We used these models to estimate the minimum surgical workforce to meet the sustainable development goals (SDGs) for U5MR and NMR and marginal effects plots to determine over which range of SAO densities the largest impact is seen as countries scale-up SAO workforce. We found that increased SAO density is associated with decreased U5MR and NMR (P < 0.05), adjusting for common non-surgical causes of child mortality. A minimum SAO density of 10 providers per 100,000 population (95% CI: 7-13) is associated with an U5MR of < 25 per 1000 live births. A minimum SAO density of 12 (95% CI: 9-20) is associated with an NMR of < 12 per 1000 live births. The maximum decrease in U5MR, on the basis of our adjusted B-spline model, occurs from 0 to 20 SAO per 100,000 population. The maximum decrease in NMR based on our adjusted B-spline model occurs up from 0 to 18 SAO, with additional decrease seen up to 80 SAO. Scale-up of the surgical workforce to 12 SAO per 100,000 population may help health systems meet the SDG goals for childhood mortality rates. Increases in up to 80 SAO/100,000 continue to offer mortality benefit for neonates and would help to achieve the SDGs for neonatal mortality reduction.

The Heterogeneous Effects of Family Structure on Early Child Health

&#x0D; Background&#x0D; Ending preventable deaths of newborns and children under 5 years of age by 2030 is one of the targets of the Sustainable Development Goals. Data from the 2013-14 Zambia Demographic and Health Survey shows that there has been improvements in some indicators of child health over the years and this has coincided with the widespread demographic changes in family formation. It’s hypothesized that children from monogamous households tend to have much better health outcomes compared to single or polygynous households. This study therefore set out to examine the effect of heterogeneous family structures on early child health.&#x0D; Methods&#x0D; Using data from the 2013-14 ZDHS, the study employed the Kids Recode (KR) data file which contains information about children under the age of five (5) of interviewed women. The analysis was conducted at three levels: descriptive, bivariate and multivariate.&#x0D; Results&#x0D; The study established that family structure had a statistically significant effect on early child health and that there was heterogeneity in the health outcomes of the children from different forms of marriage, with the ever married and polygamous marriage categories showing higher odds of having underweight children. The study also established that mother’s nutrition status, region, sex of child, mother’s age at birth of the child and child vaccination were also among other factors associated with the early child health in Zambia.&#x0D; Conclusion&#x0D; There is need for the government to implement policies that will limit the exposure of children to adverse health which would require more costly interventions later in life.&#x0D;

The feasibility and ongoing use of electronic decision support to strengthen the implementation of IMCI in KwaZulu-Natal, South Africa

BackgroundContinued efforts are required to reduce preventable child deaths. User-friendly Integrated Management of Childhood Illness (IMCI) implementation tools and supervision systems are needed to strengthen the quality of child health services in South Africa. A 2018 pilot implementation of electronic IMCI case management algorithms in KwaZulu-Natal demonstrated good uptake and acceptance at primary care clinics. We aimed to investigate whether ongoing electronic IMCI implementation is feasible within the existing Department of Health infrastructure and resources.MethodsIn a mixed methods descriptive study, the electronic IMCI (eIMCI) implementation was extended to 22 health facilities in uMgungundlovu district from November 2019 to February 2021. Training, mentoring, supervision and IT support were provided by a dedicated project team. Programme use was tracked, quarterly assessments of the service delivery platform were undertaken and in-depth interviews were conducted with facility managers.ResultsFrom December 2019 – January 2021, 9 684 eIMCI records were completed across 20 facilities, with a median uptake of 29 records per clinic per month and a mean (range) proportion of child consultations using eIMCI of 15% (1–46%). The local COVID-19-related movement restrictions and epidemic peaks coincided with declines in the monthly eIMCI uptake. Substantial inter- and intra-facility variations in use were observed, with the use being positively associated with the allocation of an eIMCI trained nurse (p < 0.001) and the clinician workload (p = 0.032).ConclusionThe ongoing eIMCI uptake was sporadic and the implementation undermined by barriers such as low post-training deployment of nurses; poor capacity in the DoH for IT support; and COVID-19-related disruptions in service delivery. Scaling eIMCI in South Africa would rely on resolving these challenges.

Time to breastfeeding cessation and its predictors among mothers who have children aged two to three years in Gozamin district, Northwest Ethiopia: A retrospective follow-up study.

Globally, breastfeeding duration is below the recommended level. In Ethiopia, more than 24% of mothers ceased breastfeeding before 24 months of age of a child which caused 14,000 preventable childhood deaths annually. To tackle this problem, current and up-to-date information regarding the time to breastfeeding cessation and its predictors is essential. Therefore, this study aims to determine the time to breastfeeding cessation and its predictors among mothers who have children aged two to three years in Gozamin district, Northwest Ethiopia. A community-based retrospective follow-up study was used among 502 mothers who have children aged two to three years in the Gozamin district from October 1, 2017, up to September 30, 2020. Interviewer-administered structured questionnaires were used. Cox proportional hazard model was applied after its assumptions and model fitness were checked, to identify predictors for time to breastfeeding cessation. The overall mean time to breastfeeding cessation was 22.56 (95%CI: 22.21, 22.91) months, and the cumulative survival probability on breastfeeding up to 24 months was 82.5% (95%CI:78.85, 85.53). The overall incidence of early breastfeeding cessation was 7.77 (95%CI:6.31, 9.58) per 1000 person-month observations. Having no antenatal care follow up (AHR:2.15, 95%CI:1.19, 3.89), having ≥4 number of children (AHR:1.76, 95%CI:1.10, 2.80), < 24 months breastfeeding experience (AHR:1.77, 95%CI:1.14, 2.75), and presence of cow milk in the household (AHR:3.01, 95%CI:1.89, 4.78) were significant predictors for time to breastfeeding cessation. The time to breastfeeding cessation is below the recommendation and therefore, strengthening breastfeeding education and related counseling at the community level is better.

Global, regional, and national trends in under-5 mortality between 1990 and 2019 with scenario-based projections until 2030: a systematic analysis by the UN Inter-agency Group for Child Mortality Estimation

SummaryBackgroundThe Sustainable Development Goals (SDGs), set in 2015 by the UN General Assembly, call for all countries to reach an under-5 mortality rate (U5MR) of at least as low as 25 deaths per 1000 livebirths and a neonatal mortality rate (NMR) of at least as low as 12 deaths per 1000 livebirths by 2030. We estimated levels and trends in under-5 mortality for 195 countries from 1990 to 2019, and conducted scenario-based projections of the U5MR and NMR from 2020 to 2030 to assess country progress in, and potential for, reaching SDG targets on child survival and the potential under-5 and neonatal deaths over the next decade.MethodsLevels and trends in under-5 mortality are based on the UN Inter-agency Group for Child Mortality Estimation (UN IGME) database on under-5 mortality, which contains around 18 000 country-year datapoints for 195 countries—nearly 10 000 of those datapoints since 1990. The database includes nationally representative mortality data from vital registration systems, sample registration systems, population censuses, and household surveys. As with previous sets of national UN IGME estimates, a Bayesian B-spline bias-reduction model (B3) that considers the systematic biases associated with the different data source types was fitted to these data to generate estimates of under-5 (age 0–4 years) mortality with uncertainty intervals for 1990–2019 for all countries. Levels and trends in the neonatal mortality rate (0–27 days) are modelled separately as the log ratio of the neonatal mortality rate to the under-5 mortality rate using a Bayesian model. Estimated mortality rates are combined with livebirths data to calculate the number of under-5 and neonatal deaths. To assess the regional and global burden of under-5 deaths in the present decade and progress towards SDG targets, we constructed several scenario-based projections of under-5 mortality from 2020 to 2030 and estimated national, regional, and global under-5 mortality trends up to 2030 for each scenario.FindingsThe global U5MR decreased by 59% (90% uncertainty interval [UI] 56–61) from 93·0 (91·7–94·5) deaths per 1000 livebirths in 1990 to 37·7 (36·1–40·8) in 2019, while the annual number of global under-5 deaths declined from 12·5 (12·3–12·7) million in 1990 to 5·2 (5·0–5·6) million in 2019—a 58% (55–60) reduction. The global NMR decreased by 52% (90% UI 48–55) from 36·6 (35·6–37·8) deaths per 1000 livebirths in 1990, to 17·5 (16·6–19·0) in 2019, and the annual number of global neonatal deaths declined from 5·0 (4·9–5·2) million in 1990, to 2·4 (2·3–2·7) million in 2019, a 51% (47–54) reduction. As of 2019, 122 of 195 countries have achieved the SDG U5MR target, and 20 countries are on track to achieve the target by 2030, while 53 will need to accelerate progress to meet the target by 2030. 116 countries have reached the SDG NMR target with 16 on track, leaving 63 at risk of missing the target. If current trends continue, 48·1 million under-5 deaths are projected to occur between 2020 and 2030, almost half of them projected to occur during the neonatal period. If all countries met the SDG target on under-5 mortality, 11 million under-5 deaths could be averted between 2020 and 2030.InterpretationAs a result of effective global health initiatives, millions of child deaths have been prevented since 1990. However, the task of ending all preventable child deaths is not done and millions more deaths could be averted by meeting international targets. Geographical and economic variation demonstrate the possibility of even lower mortality rates for children under age 5 years and point to the regions and countries with highest mortality rates and in greatest need of resources and action.FundingBill & Melinda Gates Foundation, US Agency for International Development.

Leveraging IoT solutions for enhanced health information exchange

In a bid to promote the well-being of all ages, the United Nations set a goal for eliminating preventable deaths of children below 5 years. Regular growth and health monitoring provide early warning signs for timely interventions. However, in marginalized areas, this remains a challenge due to few medical centers, low citizen income, and poor infrastructure. One way of addressing this is through Health Information Exchange (HIE) and remote infant postnatal care. Recent innovations in telehealth have revolutionized the way HIE takes place, however, some healthcare aspects call for specialized technology that is not covered by existing solutions. At present, many developing countries use Community Health Workers who visit infant homes, conduct check-ups, and give immunization vaccines. However, the large distances and populations involved limit the number of visits to those requiring vaccines only and confine monitoring to parameters measured by portable equipment only. Further, the process involves manual devices and processes, making it prone to errors and delays in interventions. The best practice would be the automation of the monitoring process and real-time data transmission.This study adopted a Design Science Research approach, with a prototype developed and tested in a simulated environment; to investigate how the Internet of Things (IoT) Technology can enhance HIE. Observations of measurements taken by the IoT and analytics server formed the primary quantitative data collection methods. The early results presented show that the prototype generates growth charts and health alerts useful for clinical research and resource planning. The solution showed acceptable accuracy levels, enforced user privacy, and efficiently utilized network resources. The system can import and export data in CVS or JSON formats, enabling it to interoperate with popular health Information systems such as DHIS2. In this way, the findings dissolve boundaries that previously challenged communication in healthcare for marginalized communities.

Oxygen systems strengthening as an intervention to prevent childhood deaths due to pneumonia in low-resource settings: systematic review, meta-analysis and cost-effectiveness

ObjectivesIncreasing access to oxygen services may improve outcomes among children with pneumonia living in low-resource settings. We conducted a systematic review to estimate the impact and cost-effectiveness of strengthening oxygen...