Trends In Under-five Mortality Research Articles

Inequalities and Trends in Under-Five Mortality Between Formal and Informal Areas in Ouagadougou, Burkina Faso.

The physical expansion of the city of Ouagadougou, the capital and largest city of Burkina Faso, subsided in 2015 after the government banned land speculation that contributed to the growth and entrenchment of informal areas. The government subsequently implemented social policies such as free health care for pregnant women and children under 5years of age. Against this background, we tested the convergence of under-5 mortality trends between formal and informal areas in the city between 2010 and 2019; data covering that period came from the Ouagadougou Health and Demographic Surveillance System (HDSS). The analyses included the calculation of all-cause and cause-specific mortality rates, the implementation of a Poisson regression model, and competing risk models. Over the study period, children in formal areas had lower mortality than those in informal areas. However, the inequality gap decreased over time due to a faster mortality decline in informal areas. This decline was explained by a rapid decline in deaths from malaria and other causes including sepsis, HIV/AIDS, measles, meningitis, and encephalitis. The pursuit of upgrading informal areas and the implementation of social policies targeting the poorest are likely to accelerate the mortality decline in Ouagadougou overall.

Trends of under-five mortality and associated risk factors in Zambia: a multi survey analysis between 2007 and 2018

BackgroundMortality at a young age is key to public health measures. This study aims to describe the burden, trend, and associated factors of under-five mortality rate (U5MR) in Zambia from 2007-to-2018.MethodA sample of 29,274 children under-five were analyzed from the Zambia demographic and health survey (ZDHS). Univariate and bivariate analysis were used to identify factors influencing U5M.ResultPooled prevalence of U5MR in Zambia was 84.4/ 1000 live-births. Over 15 years, U5M has declined by 49% (from 118.7 to 60.5/1000 live-births). Compared to children of teenage (≤19 years) mothers the likelihood of U5M was lower by 24 to 37% among children of 20 to 34 years old mothers. The likelihood of U5M was lower by 23% (AOR, 0.77 95%CI, 0.58–1.04) for poorest, 27% (AOR, 0.73 95%CI, 0.55–0.98) for poorer, and 19% (AOR, 0.81 95%CI, 0.62–1.07) for middle as compared to the richest households. The likelihood of U5M was 21% (AOR, 0.79 95%CI, 0.67–0.93) lower among rural residents. Multiple-born children died 2.54 times (95%CI, 1.95–3.98) higher than the single-born. Male children (AOR, 1.28, 95% CI, 1.23–1.46), smaller than average birth size (AOR, 1.78; 95% CI, 1.52–2.09), and no ANC visit (AOR, 3.17, 95% CI, 2.74–3.67) were associated with U5M. The likelihoods of U5M were significantly higher in the Eastern, Luapula, and Muchinga regions than in the Central.ConclusionThis study revealed that Zambia has made a gain on child survival. Further efforts targeting mothers, children, and provinces are needed to scale up the decline and achieve the SDG3.

Trends and Associated Factors of Under-five Mortality Based on 2008–2016 Data in Kersa Health and Demographic Surveillance Site, Eastern Ethiopia

Background: Of the 6.2 million estimated deaths of children under 15 years of age globally, the death toll of children under 5 years of age accounted for 5.3 million. In Ethiopia, even though significant progress has been made, facility-based research shows that the mortality rate of children under 5 is still high. In the country, particularly in the eastern part, evidence on trends in under-five mortality and associated factors from population-based longitudinal data is limited. Objective: The objective of the study was to assess under-five mortality focusing on the trends and associated factors based on 2008–2016 data in Kersa Health and Demographic Surveillance Site, Eastern Ethiopia. The method: The study was based on 9 years of surveillance data. The surveillance site was founded in 2007 with the aim of producing community-based health and demographic data in the eastern Ethiopia. Data were collected from the surveillance site and analyzed with STATA version 15 (for factor analysis) and/or Statistical Package for Social Sciences (SPSS) version 26 (for trend analysis) and Microsoft (MS) Excel software. The autoregressive integrated moving average (ARIMA) model and Mann–Kendall were used to analyze mortality trends. Multi-level logistic regression was used to assess the associated factors. Result: There were a total of 18 759 newborns in the surveillance sites, of which 1602 died of children under 5 years of age, and the total mortality rate for children under 5 years of age was 85 per 1000 live births. Trend analysis shows that the mortality rate of children under 5 has been steadily declining during the study period. Multi-level logistic regression shows that the variance of the random component model related to the intercept term is statistically significant, which means that there is a change in the mortality rate of children under 5 between the survey years, which is explained by the random intercept term. Antenatal care visits by mothers (AOR = .61, 95% CI = .49, .74), primary education (AOR = .58, 95% CI = .49, .68), normal birth weight (AOR = .78, 95% CI = .64, .95), and having 2 or fewer total births (AOR = .37, 95% CI = .22, .37) were all associated with child death. Conclusion: Despite the downward trend, the mortality rate of children under 5 years old at the surveillance sites is high. Effective intervention measures should be implemented.

Estimation of Levels and Trends of Under-Five Mortality in Sub-Saharan Africa: Evidence from Summary of Birth Histories of Currently Married Women

This present study has discussed the levels and trends of under-five mortality in sub-Sahara Africa. This study aims to estimate under-five mortality using Summary of Birth Histories (SBH) of currently married women which may provide valuable information for assessing the interventions and measures already in place to achieve Sustainable Development Goals (especially goal 3). The Trussell variant which is the modified version of the Brass model was adopted to derive under-five mortality from SBH of currently married women. The result shows that the index for under-five mortality ( ) implied by the north family of the Coale–Demeny model life tables ranges from 65.8 deaths per 1000 live births in Zambia (2018 ZDHS) to as high as 132.9 deaths per 1000 live births in Nigeria (2018 NDHS) respectively. The average estimate of under-five mortality for the countries is about 107.9 deaths per 1000 live births for currently married women and 108.4 deaths per 1000 live births for the entire women in the surveys. While the average probability of a newborn baby surviving to age 5 is about 0.8921 for currently married women that of the entire women is about 0.8915.

Levels and Trends of Under-Five Mortality in South Africa from 1998 to 2012

Levels and Trends of Under-Five Mortality in South Africa from 1998 to 2012

Trends of under-five mortality in Nineveh (2004–2013): A time series analysis

Context: Under-five mortality rate (U5MR) is the number of deaths since birth up to 5 years of age in a specific year divided by the number of live birth (LB) of the same year × 1000. It is a key indicator of child well-being including health and nutrition status, coverage of child survival interventions, and more broadly of social and economic development. Aim: The aim is to study U5MR and their cause trends in Nineveh Governorate for 10 years (2004–2013). Methodology: Design of the Study: This was a biometric (descriptive) study design. Sample of the Study: Under-five deaths plus LBs for the years 2004–2013 were taken. Research Settings: This study was carried out in Nineveh Governorate/Northwest of Iraq. Data Sources: The data were taken from vital registration system and death certificates. Outcome Measures: Various rates and proportions in addition to Chi-squared test for trend. Results:

Determinants of under Five Mortality in Ghana; A Logistic Regression Analysis Using Evidence from the Demographic and Health Survey (1988-2014)

A dramatic reduction in child mortality has been noted in Ghana in recent time and although the trend has been projected to continue to decline, studies have shown that the decline in under-five mortality has stalled and the effect more outstanding at different levels. Here we examine the issue of under five mortality using data from the demographic and health survey by examining the trends in under-five mortality between 1988-2014 and develop a predictive model to identify risk factors of under five mortality. Data from the Ghana Demographic and Health survey between 1988-2014 was used to conduct a retrospective analysis of recorded children data (0-5 years). A descriptive analysis of the explanatory and response variables was carried out followed by a subsequent trend analysis of under-five mortalities from 1988-2014. A logistic regression was used to predict the association between the explanatory variables and the dependent outcome variable. The study established that the decrease in under five mortality that Ghana witnessed from 1988-2014 was not significant and that more measures need to be put in place to reduce the phenomenon. Variables such as maternal age (R2=0.0646, p, duration of breastfeeding (R2=0.3300, pand the type of assistance at delivery (R2=0.2898, p were all strong predictors of under five mortality relative to other explanatory variables. The study identified that issues such as young maternal age, exclusive breast feeding beyond 6 months and unskilled or no assistance at birth were all contributors of under five mortality in Ghana and as such it is necessary for all these predictors to be addressed and factored during formulation and implementation of policies in an effort to curb under five mortality.

Under-five mortality among displaced populations in Meheba refugee camp, Zambia, 2008-2014.

BackgroundUnder-five mortality, which is the probability of a child dying before their fifth birthday, is of concern in Zambia as infant and child mortality rates are important social indicators. Displaced population in camps provide a basis for under-five mortality surveillance because detailed registration databases have been developed. Additionally, health data routinely collected on mortality allowed for a review of mortality trends and identification of correlating factors to under-five mortality. Literature suggests a number of factors that influence child mortality including biological, socio-econimic and environmental factors. However, while progress in reducing mortality is evident disparities in under-five mortality trends have been observed.MethodsThe study examined differential levels and trends of under-five mortality with correlating factors in Meheba refugee camp in Zambia which is presently in its post emergency phase. The retrospective cross-sectional study reviewed the ProGres and Health Information System (HIS) databases under-five mortality data for a seven (7) year period (2008–2014) and included all children aged less than five years in each year of review. STATA 12 (including Ordinary Least Squares Regression) and Microsoft Excel 2010 where used for data analysis and computation of findings.ResultsMalaria and respiratory infections accounted for 81 % of under-five deaths while cases of Diarrhoea were responsible for 10 % of reported mortalities. Seventy five percent (75 %) of all mortalities were reported in children aged less than 1 year (<1 year). While no significant variations in mortality were noted as a result of time, increased frequency of visits to health centre significantly (P < 0.05) reduced mortalities in children by 3/1000 in each year.ConclusionIn addition to improving health infrastructure and reducing distances to health facilities, the study also recommends sensitization programmes targeted at ensuring accessibility to health care services for children under-5 years. The study found that increased health centre visitations were associated with reduction in under-five mortality and encourages initiatives targeted at sensitizing communities to seek health care. Furthermore, collaboration between the health systems, community and Non Governmental Organisations (NGOs) is key in addressing higher infant mortality observed. It is envisaged that this will contribute to the reduction in mortality cases and will compliment already existing strategies.

Household Air Pollution and Under-Five Mortality in Bangladesh (2004-2011).

Household air pollution (HAP) is one of the leading causes of respiratory illness and deaths among children under five years in Bangladesh. This study investigates the association between HAP from cooking fuel and under-five mortality using Bangladesh Demographic and Health Survey (BDHS) datasets over the period 2004–2011 (n = 18,308 children), and the extent to which this association differed by environmental and behavioral factors affecting level of exposure. The association between HAP and neonatal (age between 0–28 days), infant (age between 0 and 11 months) and under–five (age between 0 and 59 months) mortality was examined using multilevel logistic regression models. HAP was not strongly associated with overall neonatal (OR = 1.49, 95% CI = 1.01–2.22, p = 0.043), infant (OR = 1.27, 95% CI = 0.91–1.77, p = 0.157) or under-five mortality (OR = 1.14, 95% CI = 0.83–1.55, p = 0.422) in the context of overall decreasing trends in under-five mortality. The association was stronger for households with an indoor kitchen using polluting fuels, and in women who had never breastfed. Reductions in exposure to pollution from cooking fuel, given it is a ubiquitous and modifiable risk factor, can result in further declines in under-five mortality with household design and behavioural interventions.

Sex-specific trends in under-five mortality in rural Ballabgarh

To assess sex-specific differentials in child survival from 1992-2011. We analyzed data from the electronic database of Health and Demographic Surveillance System (HDSS) site in Ballabgarh in North India. Sex ratio at birth was adverse for girls throughout the study period (821 to 866 girls per 1,000 boys) and was lowest in the period 2004-2006 at 821 girls per 1,000 boys. Overall, under-five mortality rates during the period 1992-2011 remained stagnant due to increasing neonatal mortality rate (9.2 to 27.7 P< 0.001). Mortality rates among girls were consistently and significantly higher than boys during the post-neonatal period (160% to 200% higher) as well as in childhood(160% to 230% higher). Strategies to address the neonatal mortality and gender differences are required for further reductions in child mortality in India.

Monitoring child survival in ‘real time’ using routine health facility records: results from Malawi

ObjectivesFew developing countries have the accurate civil registration systems needed to track progress in child survival. However, the health information systems in most of these countries do record facility births and deaths, at least in principle. We used data from two districts of Malawi to test a method for monitoring child mortality based on adjusting health facility records for incomplete coverage.MethodsTrained researchers collected reports of monthly births and deaths among children younger than 5 years from all health facilities in Balaka and Salima districts of Malawi in 2010–2011. We estimated the proportion of births and deaths occurring in health facilities, respectively, from the 2010 Demographic and Health Survey and a household mortality survey conducted between October 2011 and February 2012. We used these proportions to adjust the health facility data to estimate the actual numbers of births and deaths. The survey also provided ‘gold-standard’ measures of under-five mortality.ResultsAnnual under-five mortality rates generated by adjusting health facility data were between 35% and 65% of those estimated by the gold-standard survey in Balaka, and 46% and 50% in Salima for four overlapping 12-month periods in 2010–2011. The ratios of adjusted health facility rates to gold-standard rates increased sharply over the four periods in Balaka, but remained relatively stable in Salima.ConclusionsEven in Malawi, where high proportions of births and deaths occur in health facilities compared with other countries in sub-Saharan Africa, routine Health Management Information Systems data on births and deaths cannot be used at present to estimate annual trends in under-five mortality.

Child Mortality Estimation: Methods Used to Adjust for Bias due to AIDS in Estimating Trends in Under-Five Mortality

In most low- and middle-income countries, child mortality is estimated from data provided by mothers concerning the survival of their children using methods that assume no correlation between the mortality risks of the mothers and those of their children. This assumption is not valid for populations with generalized HIV epidemics, however, and in this review, we show how the United Nations Inter-agency Group for Child Mortality Estimation (UN IGME) uses a cohort component projection model to correct for AIDS-related biases in the data used to estimate trends in under-five mortality. In this model, births in a given year are identified as occurring to HIV-positive or HIV-negative mothers, the lives of the infants and mothers are projected forward using survivorship probabilities to estimate survivors at the time of a given survey, and the extent to which excess mortality of children goes unreported because of the deaths of HIV-infected mothers prior to the survey is calculated. Estimates from the survey for past periods can then be adjusted for the estimated bias. The extent of the AIDS-related bias depends crucially on the dynamics of the HIV epidemic, on the length of time before the survey that the estimates are made for, and on the underlying non-AIDS child mortality. This simple methodology (which does not take into account the use of effective antiretroviral interventions) gives results qualitatively similar to those of other studies.

Levels and trends in under-five mortality in Zimbabwe: findings from an analysis of recent Demographic and Health Surveys

This study describes levels and trends in infant and childhood mortality in Zimbabwe over the past 50 years with emphasis on the past fifteen years. The most important data source consisted of four Demographic and Health Surveys (DHS) surveys conducted in Zimbabwe between 1988 and 2005-06. Under-five mortality increased between 1990-1994 and 1995-1999 (from 77 per 1,000 live births to 102) and declined from 1995-1999 to 2001-2005 (from 102 to 82). The decline in this last period, as derived from Zimbabwe DHS 2005-06, was unexpected and probably not genuine. A great deal of evidence is presented to support the view that this decline in mortality probably did not take place. It is much more likely that both infant and under-five mortality increased in the period between 1995-1999 and 2001-2005. Using various procedures, this study estimates that the under-five mortality rate would actually be about 110 per 1,000 live births in 2001-2005 instead of 82 as observed in the Zimbabwe DHS 2005-06. These and other results are expected to assist policy makers and programme managers in the child health sector to formulate appropriate strategies to improve the health and well-being of children under-five in Zimbabwe.

Estimating the under-five mortality rate using a bayesian hierarchical time series model.

BackgroundMillennium Development Goal 4 calls for a reduction in the under-five mortality rate by two-thirds between 1990 and 2015, which corresponds to an annual rate of decline of 4.4%. The United Nations Inter-Agency Group for Child Mortality Estimation estimates under-five mortality in every country to measure progress. For the majority of countries, the estimates within a country are based on the assumption of a piece-wise constant rate of decline.Methods and FindingsThis paper proposes an alternative method to estimate under-five mortality, such that the underlying rate of change is allowed to vary smoothly over time using a time series model. Information about the average rate of decline and changes therein is exchanged between countries using a Bayesian hierarchical model. Cross-validation exercises suggest that the proposed model provides credible bounds for the under-five mortality rate that are reasonably well calibrated during the observation period. The alternative estimates suggest smoother trends in under-five mortality and give new insights into changes in the rate of decline within countries.ConclusionsThe proposed model offers an alternative modeling approach for obtaining estimates of under-five mortality which removes the restriction of a piece-wise linear rate of decline and introduces hierarchy to exchange information between countries. The newly proposed estimates of the rate of decline in under-5 mortality and the uncertainty assessments would help to monitor progress towards Millennium Development Goal 4.

Rapid achievement of the child survival millennium development goal: evidence from the Navrongo experiment in Northern Ghana

To determine the impact of deploying nurses and volunteers to village locations on demographic and health outcomes. We implemented an experimental design that emphasizes the value of aligning community health services with traditional social institutions that organize village life. Data for this analysis come from the Navrongo demographic surveillance system, a longitudinal database that tracks fertility, mortality, and migration events over time. The experiment uses conventional demographic methods for estimating mortality rates from longitudinal demographic surveillance registers. Posting nurses to community locations reduced childhood mortality rates by over half in 3 years and accelerated attainment of the childhood-survival millennium development goal (MDG) in the study areas relative to trends observed in comparison areas. Results from the Navrongo experiment demonstrate that community health and family planning programmes can have an impact on childhood mortality. Posting nurses to communities can dramatically accelerate the pace of progress in achieving the childhood-survival MDGs. Community-volunteer approaches, however, have no additional impact, a finding that challenges the child survival value of international investment in volunteer-based health programmes. The total cost of the intensive arm of the project is less than $10 per capita per year. Navrongo research thus demonstrates affordable means of attaining the child survival MDG agenda with existing technologies.

Comprehensive rural health services project Ballabgarh: trends in under-five mortality.

Mortality data of underfives during 1972–1974 and 1982–1984 in rural area were analysed. Underfives’ deaths were reduced by 35.9%, though the reduction was less in infants (27.2%), than in post infancy underfives (46.9%). The underfives’ death rate came down by 44.1% (from 38.3) to21.4 per 1000 underfives during the decade. The infant deaths show a uniform reduction in different age periods. The female underfives’ deaths are more than male deaths indicating a relative neglect of female children. The only diseases showing reduction in mortality in a substantial manner are tetanus and typhoid. Otherwise there is a general reduction in all causes. Prematurity, acute respiratory infections, diarrhoeal diseases, malnutrition and septicemia constituted 84.7% of deaths in infancy in 1982–84 and acute respiratory infections, malnutrition and diarrheal diseases constituted 69.7% in the 1–4 age group. This study shows how a strong referral service built into medical care with preventive and promotive methods can reduce the underfives mortality.