Survival In sub-Saharan Africa Research Articles

The Effect of Distance to Health-Care Facilities on Childhood Mortality in Rural Burkina Faso

This study aims to investigate the relation between distance to health facilities, measured as continuous travel time, and mortality among infants and children younger than 5 years of age in rural Burkina Faso, an area with low health facility density. The study included 24,555 children born between 1993 and 2005 in the Nouna Health and Demographic Surveillance System. The average walking time from each village to the closest health facility was obtained for both the dry and the rainy season, and its effect on infant (<1 year), child (1-4 years), and under-5 mortality overall was analyzed by Cox regression. The authors observed 3,426 childhood deaths, corresponding to a 5-year survival of 85%. Walking distance was significantly related to both infant and child mortality, although the shape of this effect varied distinctly between the 2 age groups. Overall, under-5 mortality, adjusted for confounding, was more than 50% higher at a distance of 4 hours compared with having a health facility in the village (P < 0.0001, 2 sided). The region of residence was an additional determinant for under-5 mortality. The findings of this study emphasize the importance of geographic accessibility of health care for child survival in sub-Saharan Africa and demonstrate the need to improve health-care access to achieve the Millennium Development Goals.

A Large Cross-Sectional Community-Based Study of Newborn Care Practices in Southern Tanzania

Despite recent improvements in child survival in sub-Saharan Africa, neonatal mortality rates remain largely unchanged. This study aimed to determine the frequency of delivery and newborn-care practices in southern Tanzania, where neonatal mortality is higher than the national average. All households in five districts of Southern Tanzania were approached to participate. Of 213,220 female residents aged 13–49 years, 92% participated. Cross-sectional, retrospective data on childbirth and newborn care practices were collected from 22,243 female respondents who had delivered a live baby in the preceding year. Health facility deliveries accounted for 41% of births, with nearly all non-facility deliveries occurring at home (57% of deliveries). Skilled attendants assisted 40% of births. Over half of women reported drying the baby and over a third reported wrapping the baby within 5 minutes of delivery. The majority of mothers delivering at home reported that they had made preparations for delivery, including buying soap (84%) and preparing a cloth for drying the child (85%). Although 95% of these women reported that the cord was cut with a clean razor blade, only half reported that it was tied with a clean thread. Furthermore, out of all respondents 10% reported that their baby was dipped in cold water immediately after delivery, around two-thirds reported bathing their babies within 6 hours of delivery, and 28% reported putting something on the cord to help it dry. Skin-to-skin contact between mother and baby after delivery was rarely practiced. Although 83% of women breastfed within 24 hours of delivery, only 18% did so within an hour. Fewer than half of women exclusively breastfed in the three days after delivery. The findings suggest a need to promote and facilitate health facility deliveries, hygienic delivery practices for home births, delayed bathing and immediate and exclusive breastfeeding in Southern Tanzania to improve newborn health.

Linkage to HIV Care and Survival Following Inpatient HIV Counseling and Testing

Linkage to HIV care and survival in sub-Saharan Africa is not well documented. In 2004 we conducted a randomized trial among medical inpatients in Mulago Hospital to assess the impact of HIV counseling and testing (HCT) on linkage to care and survival. Participants were randomized to inpatient HCT (intervention) or outpatient HCT 1 week post-discharge (control); inpatient HCT was not available at Mulago during the study. Among 590 eligible patients, 85% (500) agreed to participate; 98.8% (248) in the intervention arm received HCT compared to 68.7% (171) in the control arm. Within 6 months, 62.2% (92) of surviving HIV-infected participants received HIV care; 15.0% (20) received antiretroviral medications (ARVs). Overall mortality among HIV-infected participants was 34.6% (72). HCT had significant impact on linkage to care among surviving participants. Referral for HCT was a missed opportunity for diagnosis. There is need for earlier diagnosis and linkage to HIV care among inpatients.

Child Malaria in Sub-Saharan Africa: Effective Control and Prevention Require a Health Promotion Approach

Malaria remains a vital concern of child survival in sub-Saharan Africa despite the existence of effective curative and preventive measures. It is known that child malaria is underpinned by factors such as socioeconomic, cultural, environmental, and so forth, that must be considered simultaneously in order to effectively control it. This study applied to a rural community in Benin (West Africa) the Health Promotion concept (community participation and empowerment, contextualism, intersectorality, multistrategy, equity, and sustainability) to develop a program in order to control child malaria and close the gap of unsuccessful programs. The study design was a quasi-experimental pre-post conducted over a period of 27 months. As results, 80% of the community members participated in six of the seven sub-projects planned. The prevalence of fever (malaria) was significantly reduced after the intervention (p = 0.008). The recourse to adequate health care has significantly increased after the intervention (chi2 = 48.07, p = 0.000000). All these contributed to a statistically significant reduction of children deaths due to malaria (p = 0.001) in the village. Health Promotion strategies are likely to contribute to sustainable malaria programs' implementation that reduce malaria incidence and deaths in children under five.

Vitamin A Deficiency and Child Survival in Sub-Saharan Africa: A Reappraisal of Challenges and Opportunities

Children with vitamin A deficiency have higher risk of morbidity and mortality than vitamin A-sufficient children. Estimates on the potential child survival benefits of vitamin A deficiency control are needed for policy and program advocacy. To determine the current prevalence of children at risk for vitamin A deficiency in sub-Saharan Africa in order to estimate the potential child-survival benefits of effective and sustained policies and programs for the control of vitamin A deficiency in this region. Estimates of the prevalence of vitamin A deficiency generated in 1998, data from 11 nationally representative vitamin A deficiency surveys conducted in sub-Saharan Africa between 1997 and 2003, and the measured effects of vitamin A deficiency on child mortality were combined to estimate the prevalence of children at risk for vitamin A deficiency in sub-Saharan Africa and the potential child-survival benefits of effective and sustained policies and programs for the control of vitamin A deficiency in this region. Our analysis shows that in the absence of effective and sustained policies and programs for the control of vitamin A deficiency, an estimated 42.4% of children 0 to 59 months of age in sub-Saharan Africa (43.2 million children) are at risk for vitamin A deficiency. Such effective and sustained policy and program action for the control of vitamin A deficiency can bring about a potential 25% reduction in mortality in children 0 to 59 months with respect to 1995 mortality levels (i.e., before the onset of large-scale vitamin A supplementation programs in sub-Saharan Africa). Effective and sustained control of vitamin A deficiency has the potential to be among the most cost-effective and high-impact child-survival interventions in sub-Saharan Africa. A stronger political commitment and a more appropriate level of investment in the effective control of vitamin A deficiency could make a large contribution toward the attainment of the Millennium Development Goal for the reduction of child mortality rates by two-thirds between 1990 and 2015. Among the many challenges that Africa will need to face in the coming years, vitamin A deficiency is one that can be overcome. The need is urgent, and the solutions are known, effective, and affordable.

Infections and other causes of death in HIV-infected children in Africa

The human immunodeficiency virus (HIV) pandemic has dramatically reversed improvements in infant mortality and child survival in sub-Saharan Africa. However, accurate information on the specific causes of HIV-related morbidity and mortality arising from vertical transmission is infrequent and is constrained in resource-poor settings by infrastructure and local access to health care. Such knowledge is essential to improve clinical management of HIV-infected children in Africa. In this review, a global overview of the clinical aspects of HIV infection in children is given. Factors influencing HIV disease progression, morbidity and mortality are discussed from studies on a cohort of HIV-infected children that were followed at an orphanage in Nairobi between 1999 and 2001. These parameters are contrasted with available data on HIV-infected children residing in community settings in Africa.

The Sex Trade, Globalisation and Issues of Survival in Sub-Saharan Africa

The process of globalisation, that is the extensive political and economic restructuring that is taking place in the world in which national boundaries no longer limit the activities of institutions, involves large movements of wealth, but also of people, across the globe. The pace of this process

Female Cooperation and Conflict in Rural Mali: Effects on Infant and Child Survival

Despite notable demographic contributions to the study of social organization and infant and child survival in sub-Saharan Africa, there is a paucity in research on the relationship between household discord and child survival. Using qualitative and survey data from two ethnic groups in the West African country of Mali, this study examines the possible effects of female cooperation and conflict on infant and child survival. Results suggest that cultural norms that stress the importance of cooperation do not necessarily translate into collective childcare strategies nor increase survival chances of infants and children. Conversely, household living arrangements marked by conflict do not negatively impact child welfare. Through an innovative methodology, this study underscores the need for a more sophisticated use of anthropological theory and methods in understanding the role of culture in demographic processes.

The Sex Trade, Globalisation and Issues of Survival in Sub-Saharan Africa

The process of globalisation, that is the extensive political and economic restructuring that is taking place in the world in which national boundaries no longer limit the activities of institutions, involves large movements of wealth, but also of people, across the globe. The pace of this process is largely being set by Supranational corporations and international financial institutions, as well as organized crime syndicates, most of whom have more wealth than the entire GNPs of most Third World countries. Within this context sex has become an international commodity in high demand, being exchanged (and I will argue, often stolen) not only within countries, but also across borders. Tourists, military personnel, state officials, expatriates, itinerant traders and truck drivers, traffickers, pimps, refugees, children, parents are all involved in this process. In a global market in which females continue to be disadvantaged, it is not surprising that women and children are the first victims of this process of global sexual exchange, often becoming slaves to powerful brokers even within their own countries. Pino Arlaecki, who heads the UN effort to fight organized crime says, Slavery is one of the most undesirable consequences of globalization... we regret that it is not considered as a priority by any country at the moment (as cited in Hughes 1999).

African Feminism. The Politics of Survival in Sub-Saharan Africa

African Feminism. The Politics of Survival in Sub-Saharan Africa

Improvements in childhood mortality in The Gambia

1to our report 2 rightly draws attention to the numerous factors that can be invoked to explain the substantial gains in child survival in sub-Saharan Africa since the 1950s. Our report focused on The Gambia, however, since its percentage reduction of mortality among children younger than age 5 years from 1980 to 1995 was ranked first in all of sub-Saharan Africa. We used national census data from 1983 and 1993 and data from villages around Farafenni under continuous surveillance since 1981 in our study, and suggest that there is an additional reduction in child mortality that we believe is attributable to the effects of village-based health services.The figure in our report showed that the pace of mortality decline speeded up after primary health care was adopted. Villages with community health nurses, village health workers, and trained birth attendants had a faster mortality decline that did villages without such personnel. 2

African Feminism: The Politics of Survival in Sub-Saharan Africa

African Feminism: The Politics of Survival in Sub-Saharan Africa

African feminism: the politics of survival in sub-Saharan Africa

African feminism: the politics of survival in sub-Saharan Africa

Insecticide‐treated bednets reduce mortality and severe morbidity from malaria among children on the Kenyan coast

New tools to prevent malaria morbidity and mortality are needed to improve child survival in sub-Saharan Africa. Insecticide treated bednets (ITBN) have been shown, in one setting (The Gambia, West Africa), to reduce childhood mortality. To assess the impact of ITBN on child survival under different epidemiological and cultural conditions we conducted a community randomized, controlled trial of permethrin treated bednets (0.5 g/m2) among a rural population on the Kenyan Coast. Between 1991 and 1993 continuous community-based demographic surveillance linked to hospital-based in-patient surveillance identified all mortality and severe malaria morbidity events during a 2-year period among a population of over 11000 children under 5 years of age. In July 1993, 28 randomly selected communities were issued ITBN, instructed in their use and the nets re-impregnated every 6 months. The remaining 28 communities served as contemporaneous controls for the following 2 years, during which continuous demographic and hospital surveillance was maintained until the end of July 1995. The introduction of ITBN led to significant reductions in childhood mortality (PE 33%, CI 7-51%) and severe, life-threatening malaria among children aged 1-59 months (PE 44%, CI 19-62). These findings confirm the value of ITBN in improving child survival and provide the first evidence of their specific role in reducing severe morbidity from malaria.