Under-5 Deaths Research Articles

National and regional under-5 mortality rate by economic status for low-income and middle-income countries: a systematic assessment.

SummaryBackgroundThe progress to achieve the fourth Millennium Development Goal in reducing mortality rate in children younger than 5 years since 1990 has been remarkable. However, work remains to be done in the Sustainable Development Goal era. Estimates of under-5 mortality rates at the national level can hide disparities within countries. We assessed disparities in under-5 mortality rates by household economic status in low-income and middle-income countries (LMICs).MethodWe estimated country-year-specific under-5 mortality rates by wealth quintile on the basis of household wealth indices for 137 LMICs from 1990 to 2016, using a Bayesian statistical model. We estimated the association between quintile-specific and national-level under-5 mortality rates. We assessed the levels and trends of absolute and relative disparity in under-5 mortality rate between the poorest and richest quintiles, and among all quintiles.FindingsIn 2016, for all LMICs (excluding China), the aggregated under-5 mortality rate was 64·6 (90% uncertainty interval [UI] 61·1–70·1) deaths per 1000 livebirths in the poorest households (first quintile), 31·3 (29·5–34·2) deaths per 1000 livebirths in the richest households (fifth quintile), and in between those outcomes for the middle quintiles. Between 1990 and 2016, the largest absolute decline in under-5 mortality rate occurred in the two poorest quintiles: 77·6 (90% UI 71·2–82·6) deaths per 1000 livebirths in the poorest quintile and 77·9 (72·0–82·2) deaths per 1000 livebirths in the second poorest quintile. The difference in under-5 mortality rate between the poorest and richest quintiles decreased significantly by 38·8 (90% UI 32·9–43·8) deaths per 1000 livebirths between 1990 and 2016. The poorest to richest under-5 mortality rate ratio, however, remained similar (2·03 [90% UI 1·94–2·11] in 1990, 1·99 [1·91–2·08] in 2000, and 2·06 [1·92–2·20] in 2016). During 1990–2016, around half of the total under-5 deaths occurred in the poorest two quintiles (48·5% in 1990 and 2000, 49·5% in 2016) and less than a third were in the richest two quintiles (30·4% in 1990, 30·5% in 2000, 29·9% in 2016). For all regions, differences in the under-5 mortality rate between the first and fifth quintiles decreased significantly, ranging from 20·6 (90% UI 15·9–25·1) deaths per 1000 livebirths in eastern Europe and central Asia to 59·5 (48·5–70·4) deaths per 1000 livebirths in south Asia. In 2016, the ratios of under-5 mortality rate in the first quintile to under-5 mortality rate in the fifth quintile were significantly above 2·00 in two regions, with 2·49 (90% UI 2·15–2·87) in east Asia and Pacific (excluding China) and 2·41 (2·05–2·80) in south Asia. Eastern and southern Africa had the smallest ratio in 2016 at 1·62 (90% UI 1·48–1·76). Our model suggested that the expected ratio of under-5 mortality rate in the first quintile to under-5 mortality rate in the fifth quintile increases as national-level under-5 mortality rate decreases.InterpretationFor all LMICs (excluding China) combined, the absolute disparities in under-5 mortality rate between the poorest and richest households have narrowed significantly since 1990, whereas the relative differences have remained stable. To further narrow the rich-and-poor gap in under-5 mortality rate on the relative scale, targeted interventions that focus on the poorest populations are needed.FundingNational University of Singapore, UN Children's Fund, United States Agency for International Development, and the Bill & Melinda Gates Foundation.

Accelerating newborn survival in Ghana through a low-dose, high-frequency health worker training approach: a cluster randomized trial

BackgroundNewborn deaths comprise nearly half of under-5 deaths in Ghana, despite the fact that skilled birth attendants (SBAs) are present at 68% of births, which implies that evidence-based care during labor, birth and the immediate postnatal period may be deficient. We assessed the effect of a low-dose, high-frequency (LDHF) training approach on long-term evidence-based skill retention among SBAs and impact on adverse birth outcomes.MethodsFrom 2014 to 2017, we conducted a cluster-randomized trial in 40 hospitals in Ghana. Eligible hospitals were stratified by region and randomly assigned to one of four implementation waves. We assessed the relative risks (RRs) of institutional intrapartum stillbirths and 24-h newborn mortality in months 1–6 and 7–12 of implementation as compared to the historical control period, and in post-intervention facilities compared to pre-intervention facilities during the same period. All SBAs providing labor and delivery care were invited to enroll; their knowledge and skills were assessed pre- and post-training, and 1 year later.ResultsAdjusting for region and health facility type, the RR of 24-h newborn mortality in the 40 enrolled hospitals was 0·41 (95% CI 0·32–0·51; p < 0.001) in months 1–6 and 0·30 (95% CI 0·21–0·43; p < 0·001) in months 7–12 compared to baseline. The adjusted RR of intrapartum stillbirth was 0·64 (95% CI 0·53–0·77; p < 0·001) in months 1–6 and 0·48 (95% CI 0·36–0·63; p < 0·001) in months 7–12 compared to baseline. Four hundred three SBAs consented and enrolled. After 1 year, 200 SBAs assessed had 28% (95% CI 25–32; p < 0·001) and 31% (95% CI 27–36; p < 0·001) higher scores than baseline on low-dose 1 and 2 content skills, respectively.ConclusionsThis training approach results in a sustained decrease in facility-based newborn mortality and intrapartum stillbirths, and retained knowledge and skills among SBAs after a year. We recommend use of this approach for future maternal and newborn health in-service training and programs.Trial registrationRetrospectively registered on 25 September 2017 at Clinical Trials, identifier NCT03290924.

Child mortality in South Africa: Fewer deaths, but better data are needed

South Africa is committed to reducing under-5 mortality rates in line with the Sustainable Development Goal (SDG) targets. Policymakers and healthcare service managers require accurate and complete data on the number and causes of child deaths to plan and monitor healthcare service delivery and health outcomes. This study aimed to review nationally representative data on under-5 mortality and the cause of deaths among children under 5 years of age. We also reviewed systems that are currently used for generating these data. Child mortality has declined substantially in the past decade. Under-5 mortality in 2015 is estimated at 37 - 40 deaths per 1 000 live births, with an estimated infant mortality rate of 27 - 33 deaths per 1 000 live births. Approximately one-third of under-5 deaths occur during the newborn period, while diarrhoea, pneumonia and HIV infection remain the most important causes of death outside of the newborn period. The proportion of deaths owing to non-natural causes, congenital disorders and non-communicable diseases has increased. However, many discrepancies in data collected through different systems are noted, especially at the sub-national level. There is a need to improve the completeness and accuracy of existing data systems and to strengthen reconciliation and triangulation of data.

Estimates of global and regional prevalence of neural tube defects for 2015: a systematic analysis.

Neural tube defects (NTDs) are associated with substantial mortality, morbidity, disability, and psychological and economic costs. Many are preventable with folic acid, and access to appropriate services for those affected can improve survival and quality of life. We used a compartmental model to estimate global and regional birth prevalence of NTDs (live births, stillbirths, and elective terminations of pregnancy) and subsequent under-5 mortality. Data were identified through web-based reviews of birth defect registry databases and systematic literature reviews. Meta-analyses were undertaken where appropriate. For 2015, our model estimated 260,100 (uncertainty interval (UI): 213,800-322,000) NTD-affected birth outcomes worldwide (prevalence 18.6 (15.3-23.0)/10,000 live births). Approximately 50% of cases were elective terminations of pregnancy for fetal anomalies (UI: 59,300 (47,900-74,500)) or stillbirths (57,800 (UI: 35,000-88,600)). Of NTD-affected live births, 117,900 (∼75%) (UI: 105,500-186,600) resulted in under-5 deaths. Our systematic review showed a paucity of high-quality data in the regions of the world with the highest burden. Despite knowledge about prevention, NTDs remain highly prevalent worldwide. Lack of surveillance and incomplete ascertainment of affected pregnancies make NTDs invisible to policy makers. Improved surveillance of all adverse outcomes is needed to improve the robustness of total NTD prevalence estimation, evaluate effectiveness of prevention through folic acid fortification, and improve outcomes through care and rehabilitation.

The Levels of Neonatal Care Practices at Health Facilities and Home Deliveries in Rural Sidama Zone, Southern Ethiopia.

Background: Globally, there has been progress in reducing maternal and under-5 child deaths in the past 2 decades; however, the progress in reducing newborn mortality has been slower with estimated 3 million neonatal deaths per year. In Ethiopia, unhealthy newborn care is common at home deliveries compared with institutional births that might be associated with neonatal deaths. The purpose of the current study was to assess the practices of immediate newborn care at home and institutional deliveries in rural Sidama Zone, 2017. Methods: A population-based cross-sectional survey was used. The study was conducted in 5 districts of Sidama Zone, from January 21 to February 4, 2017. A total of 2300 mothers who gave live births in the past 6 months were selected using a 2-stage cluster sampling methods. Data were entered, cleaned, and recoded using Epi Data and SPSS for analysis. Accordingly, descriptive and bivariate analyses were done, and the results are presented using P values. Results: The response rate was 99% (2279/2300). About one-third of the mothers are in the age group of 20 to 24 years, and 94.6% of them had at least 1 antenatal care follow-up. Most (72%) mothers delivered at health facilities. The practices of skin to skin care of the babies was 52% (61% at health facilities, 28% at home; P < .002). Baby bathing delay for at least 24 hours was 78% and clean cord care was 73% overall (home 21% vs health institution 93.6%). The cord was not tied in 11.6% of cases all of whom were home births (P < .001). As to immediate breastfeeding of the child, most (78%) of the babies were put to the breast within an hour of birth with no significant difference between the 2 places of births (P = .75). Conclusion: In this study, giving birth at health facilities did not make immediate newborn care practices universal, but unhealthy practices were more common among home births. Therefore, more efforts to promote community-based immediate newborn care are needed with great emphasis to proper thermal care.

Assessment of the quality of neonatal care in the Solomon Islands.

To identify strengths and obstacles for improving the quality of newborn care in the Solomon Islands. Improving the quality of newborn care is a priority in the Sustainable Development Goals and the Action Plan for Healthy Newborns in the Western Pacific. The neonatal mortality rate in the Solomon Islands, a lower-middle-income country, has improved slower than overall child mortality. In 2013, neonatal mortality (13.2/1000) constituted 44% of under-5 deaths (30.1/1000). A cross-sectional study of newborn care in five provincial hospitals using a World Health Organization assessment tool for hospital quality of care. Twelve months of neonatal records of the National Referral Hospital (NRH) labour ward and nursery were audited. Essential medications and basic equipment were generally available. Challenges included workforce shortages and lack of expertise, high costs, organisation and maintenance of equipment, infection control and high rates of stillbirth. Over 12 months at the NRH labour ward, there were 5412 live births, 65 (1.2%) 'fresh' stillbirths and 96 (1.8%) 'macerated' stillbirths. Over the same period, there were an associated 779 nursery admissions, and the main causes of mortality were complications of prematurity, birth asphyxia, congenital abnormalities and sepsis. Total neonatal mortality at NRH was 16 per 1000 live births, and 77% of deaths occurred in the first 3 days of life. Infrastructure limitations, technical maintenance and equipment organisation were obstacles to newborn care. Greater health-care worker knowledge and skills for early essential newborn care, infection control and management of newborn complications is needed.

Comprehensive review of the evidence regarding the effectiveness of community-based primary health care in improving maternal, neonatal and child health: 3. neonatal health findings.

BackgroundAs the number of deaths among children younger than 5 years of age continues to decline globally through programs to address the health of older infants, neonatal mortality is becoming an increasingly large proportion of under–5 deaths. Lack of access to safe delivery care, emergency obstetric care and postnatal care continue to be challenges for reducing neonatal mortality. This article reviews the available evidence regarding the effectiveness of community–based primary health care (CBPHC) and common components of programs aiming to improve health during the first 28 days of life.MethodsA database comprising evidence of the effectiveness of projects, programs and field research studies (referred to collectively as projects) in improving maternal, neonatal and child health through CBPHC has been assembled and described elsewhere in this series. From this larger database (N = 548), a subset was created from assessments specifically relating to newborn health (N = 93). Assessments were excluded if the primary project beneficiaries were more than 28 days of age, or if the assessment did not identify one of the following outcomes related to neonatal health: changes in knowledge about newborn illness, care seeking for newborn illness, utilization of postnatal care, nutritional status of neonates, neonatal morbidity, or neonatal mortality. Descriptive analyses were conducted based on study type and outcome variables. An equity assessment was also conducted on the articles included in the neonatal subset.ResultsThere is strong evidence that CBPHC can be effective in improving neonatal health, and we present information about the common characteristics shared by effective programs. For projects that reported on health outcomes, twice as many reported an improvement in neonatal health as did those that reported no effect; only one study demonstrated a negative effect. Of those with the strongest experimental study design, almost three–quarters reported beneficial neonatal health outcomes. Many of the neonatal projects assessed in our database utilized community health workers (CHWs), home visits, and participatory women’s groups. Several of the interventions used in these projects focused on health education (recognition of danger signs), and promotion of and support for exclusive breastfeeding (sometimes, but not always, including early breastfeeding). Almost all of the assessments that included a measurable equity component showed that CBPHC produced neonatal health benefits that favored the poorest segment of the project population. However, the studies were quite biased in geographic scope, with more than half conducted in South Asia, and many were pilot studies, rather than projects at scale.ConclusionsCBPHC can be effectively employed to improve neonatal health in high–mortality, resource–constrained settings. CBPHC is especially important for education and support for pregnant and postpartum mothers and for establishing community–facility linkages to facilitate referrals for obstetrical emergencies; however, the latter will only produce better health outcomes if facilities offer timely, high–quality care. Further research on this topic is needed in Africa and Latin America, as well as in urban and peri–urban areas. Additionally, more assessments are needed of integrated packages of neonatal interventions and of programs at scale.

Mortality among twins and singletons in sub-Saharan Africa between 1995 and 2014: a pooled analysis of data from 90 Demographic and Health Surveys in 30 countries.

Sub-Saharan Africa has the world's highest under-5 and neonatal mortality rates as well as the highest naturally occurring twin rates. Twin pregnancies carry high risk for children and mothers. Under-5 mortality has declined in sub-Saharan Africa over the last decades. It is unknown whether twins have shared in this reduction. We pooled data from 90 Demographic and Health Surveys for 30 sub-Saharan Africa countries on births reported between 1995 and 2014. We used information on 1 685 110 singleton and 56 597 twin livebirths to compute trends in mortality rates for singletons and twins. We examined whether the twin-singleton rate ratio can be attributed to biological, socioeconomic, care-related factors, or birth size, and estimated the mortality burden among sub-Saharan African twins. Under-5 mortality among twins has declined from 327·7 (95% CI 312·0-343·5) per 1000 livebirths in 1995-2001 to 213·0 (196·7-229·2) in 2009-14. This decline of 35·0% was much less steep than the 50·6% reduction among singletons (from 128·6 [95% CI 126·4-130·8] per 1000 livebirths in 1995-2001 to 63·5 [61·6-65·3] in 2009-14). Twins account for an increasing share of under-5 deaths in sub-Saharan Africa: currently 10·7% of under-5 mortality and 15·1% of neonatal mortality. We estimated that about 315 000 twins (uncertainty interval 289 000-343 000) die in sub-Saharan African each year. Excess twin mortality cannot be explained by common risk factors for under-5 mortality, including birthweight. The difference with singletons was especially stark for neonatal mortality (rate ratio 5·0, 95% CI 4·5-5·6). 51·7% of women pregnant with twins reported receiving medical assistance at birth. The fate of twins in sub-Saharan Africa is lagging behind that of singletons. An alarming one-fifth of twins in the region dies before age 5 years, three times the mortality rate among singletons. Twins account for a substantial and growing share of under-5 and neonatal mortality, but they are largely neglected in the literature. Coordinated action is required to improve the situation of this extremely vulnerable group. None.

Neonatal resuscitation in global health settings: an examination of the past to prepare for the future.

As rates of childhood mortality decline, neonatal deaths account for nearly half of under-5 deaths worldwide. Intrapartum-related events (birth asphyxia) contribute to approximately one-quarter of neonatal deaths, many of which can be prevented by simple resuscitation and newborn care interventions. This paper reviews various lines of research that have influenced the global neonatal resuscitation landscape. A brief situational analysis of asphyxia-related newborn mortality in low-resource settings is linked to renewed efforts to reduce neonatal mortality in the Every Newborn Action Plan. Possible solutions to gaps in care are identified. Building on international scientific evidence, tests of educational efficacy, and community-based trials established the feasibility and effectiveness of training in resource-limited settings and identified successful implementation strategies. Implementation of neonatal resuscitation programs has been shown to decrease intrapartum stillbirth rates and early neonatal mortality. Challenges remain with respect to provider competencies, coverage, and quality of interventions. The combination of resuscitation science, strategies to increase educational effectiveness, and implemention of interventions with high coverage and quality has resulted in reduced rates of asphyxia-related neonatal mortality. Further efforts to improve coverage and implementation of neonatal resuscitation will be necessary to meet the 2035 goal of eliminating preventable newborn deaths.

Cause of death in under 5 children in a demographic surveillance site in Pakistan

ObjectiveTo identify Cause of deaths among children below age of 5yearsfrom a prospective cohort of women in one urban and four peri-urbansettings of Karachi, PakistanIntroductionPakistan ranks 26th in Childhood mortality rates, globally. Pakistan,with other 4 countries is responsible for about half of the deaths ofchildren age under 5. Despite such burden vital registration systemis not well established, health facilities are not easily accessible andmostly deaths occur at home, making identification of cause of death(COD) difficultMethodsFrom Jan 2007-Dec 2012 under-5 mortality was identifiedby CHWs during their 3-monthly visits. A Research Assistantconducted Verbal Autopsies (VA). Each VA form was analyzed by2 physicians, independently, and assigned a cause. VA is analyzedby a third physician in case two physicians do not agree on a cause.Cause Specific Mortality Fractions (CSMF) were calculated for eachidentified COD.Results833(58%) neonatal deaths and 591(42%) Under-5 deaths (excludingneonates) were identified. Among neonates most common CODswere perinatal asphyxia(30.4%), neonatal sepsis/meningitis(28%),pre-term birth complication(11%) and neonatal pneumonia(6%).For Post-neonatal deaths most common CODs were sepsis (19%),diarrheal disease (17%), Pneumonia (17%) and meningitis (8%).ConclusionsWe describe the CSMF for different CODs among neonated andchildren under 5. Strategies for prevention of most common causesand making health facilities easily accessible will decrease thisburden.

Leading causes of child mortality in Brazil, in 1990 and 2015: estimates from the Global Burden of Disease study.

To analyze under-5 mortality rates and leading causes in Brazil and states in 1990 and 2015, using the Global Burden of Disease Study (GBD) 2015 estimates. The main sources of data for all-causes under-5 mortality and live births estimates were the mortality information system, surveys, and censuses. Proportions and rates per 1,000 live births (LB) were calculated for total deaths and leading causes. Estimates of under-5 deaths in Brazil were 191,505 in 1990, and 51,226 in 2015, 90% of which were infant deaths. The rates per 1,000 LB showed a reduction of 67.6% from 1990 to 2015, achieving the proposed target established by the Millennium Development Goals (MDGs). The reduction generally was more than 60% in states, with a faster reduction in the poorest Northeast region. The ratio of the highest and lowest rates in the states decreased from 4.9 in 1990 to 2.3 in 2015, indicating a reduction in socioeconomic regional disparities. Although prematurity showed a 72% reduction, it still remains as the leading cause of death (COD), followed by diarrheal diseases in 1990, and congenital anomalies, birth asphyxia and septicemia neonatal in 2015. Under-5 mortality has decreased over the past 25 years, with reduction of regional disparities. However, pregnancy and childbirth-related causes remain as major causes of death, together with congenital anomalies. Intersectoral and specific public health policies must be continued to improve living conditions and health care in order to achieve further reduction of under-5 mortality rates in Brazil.

Strengthening the global paediatric workforce: the need for a global strategy to ensure better health outcomes for children

Paediatric training and the practise of paediatrics is built on the bedrock of ensuring best possible health outcomes for all children, optimising opportunity for those without full health and contributing...

Patterns and Trends in the Attributable Fractions of under-5 Years Hospitalization and Inpatient Death for Neonates, Infectious Diseases, and Severe Acute Malnutrition in Yemen: A Retrospective Data Analysis

Objectives: To examine trends in hospitalization and inpatient deaths of neonates, and infectious diseases (IDs) between 2005-2014; and severe acute malnutrition (SAM) between 2010 and 2014 in Yemen. Method: It was a retrospective descriptive study. Data were extracted from the clinical records of the patients admitted from 2005 to 2014 for neonates and cases aged 1-59 months with IDs. For cases with SAM data were available from 2010 to 2014. Data were analyzed using SPSS version 20. Results: Between 2005 and 2014, 39282 under-5 hospitalized and 33.6% were neonates. Of 26069 aged 1-59 months, 15224(58.4%) hospitalized with IDs. Pneumonia (44.6%), diarrhea (29.9%), and meningitis (10.6%) were the main subgroups. During the study period, there were 4183 under-5 deaths. Neonatal deaths accounting for 3671 (87.8%). Deaths aged 1-59 month were 512(12.2%) and IDs contributing 440(85.9%). Compared to 2005/06, neonatal hospitalization and death declined by 9.2% and 18.1% in 2013/14, and IDs by 56.8% and 79.2%, respectively. Pneumonia reductions were 65.4% and 83.7%, diarrhea 42% and 95.5%, and meningitis 73% and 83%, respectively. Between 2010-2014, SAM cases were 1781 of 13689 total hospitalization [13% (95%CI 12.5-13.6)] and 53 SAM deaths of 224 total deaths [23.7 % (18.6-29.6)]. SAM hospitalization rate increased from 8.5% in 2010, to 18.4% in 2014 and death rate increased from 27% (17.6-39.0) to 57.5% (42.2-71.5), respectively. Conclusion: Despite significant decline in IDs and vaccine preventable diseases, this study showed 87.8% of under-5 mortality were neonates. The increasing trends in SAM hospitalization and death are alarming. Interventions to improve neonatal survival and to reduce SAM morbidity and mortality are urgently needed.

Study of risk factors in children with birth asphyxia

Background: Birth asphyxia is a serious clinical problem worldwide and contributes greatly to neonatal mortality and morbidity. Perinatal asphyxia is the fifth largest cause of under-5 deaths (8.5%) after pneumonia, diarrhea, neonatal infections and complications of preterm birth. Risk factors of birth asphyxia have been divided into antepartum, intrapartum and fetal. Risk factors include increasing or decreasing ma-ternal age, prolonged rupture of membranes, meconium stained fluid, multiple births, non-attendance for antenatal care, low birth weight infants, malpresentation, augmentation of labour with oxytocin, antepartum haemorrhage, severe eclampsia and pre-eclampsia, ante partum and intrapartum anemia. The objective of this study was to study the risk factors in children with birth asphyxia.Methods: Observational prospective study was conducted on babies delivered in our hospital and requiring resuscitation (basic and/or advanced). Their clinical course was observed and studied in NICU till time of discharge or death. Detailed maternal history was taken for risk factors.Results: The mean age of mothers was 24.28 years which ranged from 20 years to 29 years. Most of the population was from the lower middle and upper lower socioeconomic status as per the Modified Kuppuswamy scale. 51% neonates were born to primiparous mothers. Anemia was widely prevalent in the moth-ers of neonates requiring resuscitation. The maternal risk factors for newborns requiring resuscita-tion were PIH (23.7%) , oligohydramnios (15%),multiple gestation (3.75 %), PROM (2.5%), diabetes mellitus (2.5%) and UTI (2.5%).One third of neonates requiring resuscitation were born to unbooked mothers.In the neonates requiring resuscitation, the male to female ratio was 1:1. The fetal factors associated with resuscitation of newborns were IUGR (33.75%), fetal distress (31.25%), prematurity (26.25%), MAS (12.5%) and malpresentations (5%).Conclusions: The most common maternal risk factors for newborns requiring resuscitation was PIH followed by oligohydramnios, multiple gestation, PROM, diabetes mellitus and UTI.IUGR was the most com-mon fetal risk factor followed by fetal distress, prematurity, MAS and malpresentations. One third of neonates requiring resuscitation were born to unbooked mothers. In There was no gender predomi-nance found in this study.

Poor oral health as a predictor for preterm births: Do we need to revisit antenatal care guidelines for reducing preterm births? Reflections from rural Gujarat

Background: Prematurity is one of the leading cause of under-5 deaths and single most important cause of neonatal mortality globally as well as in India. Still, there is a dearth of field-based research on preterm births (PTB) and its risk factors, especially in high burden countries like India. Evidence from developed countries indicates a possible association between poor oral health and PTB. However, the lack of similar evidence in India leads to a pressing need to conduct such studies. Objectives: The present study focuses on descriptive review and triangulates the observation with a cohort study conducted in Gujarat for exploring risk factors for PTB. Materials and Methods: A descriptive review on the association between PTB and periodontal disease was done using search engine such as PubMed and Google Scholar. The findings were triangulated with the observation of a cohort study conducted among 2154 antenatal mothers in four districts of Gujarat, India. Results: A number of studies have investigated the potential association between periodontal diseases and PTB but results are controversial; however, a community-based cohort study from Gujarat identified periodontal disease as an independent risk factor for PTB (adjusted odds ratio - 11). Conclusion: Although various studies highlighted that periodontal disease is an independent risk factor for PTB, oral health is often neglected during pregnancy. Simple oral health screening and treatment can play crucial role in the prevention of periodontal diseases. Unfortunately, in current antenatal care guidelines, oral health screening is missing. Hence, there is a dire need for strengthening guidelines including encouraging women to seek oral screening, counseling on maintaining appropriate oral hygiene during pregnancy.

Meeting the Sustainable Development Goal Zero Targets: What Could We Do?

The Sustainable Development Goals are an ambitious set of targets for global development progress by 2030 that were agreed by the United Nations in 2015. Amongst the 169 targets are a number that call for universal access, universal coverage, or universal eradication. These include ending extreme poverty and malnutrition alongside preventable under-5 deaths, ending a number of epidemics, providing universal access to sexual and reproductive health services, primary and secondary education, a range of infrastructure services, and legal identification. These have often been labeled “zero targets.” A review of the literature on meeting these zero targets suggests very high costs compared to available resources, but also that in many cases there remains a considerable gap between financing known technical solutions and achieving the outcomes called for in the SDGs. In some cases, we (even) lack the technical solutions required to achieve the zero targets, suggesting the need for research and development of new approaches.

Ending Preventable Child Deaths from Pneumonia and Diarrhoea in Afghanistan: An Analysis of Intervention Coverage Scenarios Using the Lives Saved Tool.

Background. Despite improvements in child health, Afghanistan still has a heavy burden of deaths due to preventable causes: 17% of under-5 deaths are due to pneumonia and 12% are due to diarrhoea. Objective. This article describes the situation of childhood pneumonia and diarrhoea in Afghanistan, including efforts to prevent, protect, and treat the two diseases. It estimates lives saved by scaling up interventions. Methods. A secondary analysis of data was conducted and future scenarios were modelled to estimate lives saved by scaling up a package of interventions. Results. The analysis reveals that 10,795 additional child deaths could be averted with a moderate scale-up of interventions, decreasing the under-five mortality rate in Afghanistan from 55 per 1,000 live births in 2015 to 40 per 1,000 in 2020. In an ambitious scale-up scenario, an additional 15,096 lives could be saved. There would be a 71% reduction in child deaths due to these two causes between 2016 and 2020 in the ambitious scenario compared to 47% reduction in the moderate scenario. Conclusion. Significant reductions in child mortality can be achieved through scale-up of essential interventions to prevent and treat pneumonia and diarrhoea. Strengthened primary health care functions and multisector collaboration on child health are suggested.

Mapping Neonatal Mortality in India: A Closer Look.

Introduction:Fifty-three percent of Indian under-5 deaths occur during the neonatal age group. Recognizing that there is a lack of illustrated district-level data on neonatal mortality in India, we mapped this to visually highlight districts where neonatal health issues require the most attention.Methods:District-level estimates of 596 Indian districts were used to generate maps and to illustrate neonatal mortality rates (NMRs), absolute numbers of neonatal deaths; the best and worst performing districts (positive and negative deviants) in each Indian state; the neonatal female/male death ratio; and district lag in NMR reductions.Results:The NMR ranged from 4.3 (Kannur, Kerala) to 65.1 (Datia, Madhya Pradesh), with the mean NMR being 29.8. Almost two-thirds of the districts (n = 380, 63.7%) had NMRs between 20 and 40. The top third of neonatal deaths could be accounted for by just 71 districts of a total of 596.Conclusion:There is an urgent need for up-to-date data on district-level neonatal mortality in India.

Does spending on refugees make a difference? A cross-sectional study of the association between refugee program spending and health outcomes in 70 sites in 17 countries.

BackgroundNumerous simultaneous complex humanitarian emergencies strain the ability of local governments and the international community to respond, underscoring the importance of cost-effective use of limited resources. At the end of 2011, 42.5 million people were forcibly displaced, including 10.4 million refugees under the mandate of the United Nations High Commissioner for Refugees (UNHCR). UNHCR spent US$1.65 billion on refugee programs in 2011. We analyze the impact of aggregate-level UNHCR spending on mortality of refugee populations.MethodsUsing 2011 budget data, we calculated purchasing power parity adjusted spending, disaggregated by population planning groups (PPGs) and UNHCR Results Framework objectives. Monthly mortality reported to UNHCR’s Health Information System from 2011 to 2012 was used to calculate crude (CMR) and under-5 (U5MR) mortality rates, and expressed as ratios to country of asylum mortality. Log-linear regressions were performed to assess correlation between spending and mortality.ResultsMortality data for 70 refugee sites representing 1.6 million refugees in 17 countries were matched to 20 PPGs. Median 2011 spending was $623.27 per person (constant 2011 US$). Median CMR was 2.4 deaths per 1,000 persons per year; median U5MR was 18.1 under-5 deaths per 1,000 live births per year. CMR was negatively correlated with total spending (p = 0.027), and spending for fair protection processes and documentation (p = 0.005), external relations (p = 0.034), logistics and operations support (p = 0.007), and for healthcare (p = 0.046). U5MR ratio was negatively correlated with total spending (p = 0.015), and spending for favorable protection environment (p = 0.024), fair protection processes and documentation (p = 0.003), basic needs and essential services (p = 0.027), and within basic needs, for healthcare services (p = 0.007).ConclusionIncreased UNHCR spending on refugee populations is correlated with lower mortality, likely reflecting unique refugee vulnerabilities and dependence on aid. Future analyses using more granular data can further elucidate the health impact of humanitarian sector spending, thereby guiding policy choices.Electronic supplementary materialThe online version of this article (doi:10.1186/s13031-016-0095-4) contains supplementary material, which is available to authorized users.

Trends, causes, and risk factors of mortality among children under 5 in Ethiopia, 1990-2013: findings from the Global Burden of Disease Study 2013.

BackgroundEthiopia has made remarkable progress in reducing child mortality over the last two decades. However, the under-5 mortality rate in Ethiopia is still higher than the under-5 mortality rates of several low- and middle-income countries (LMIC). On the other hand, the patterns and causes of child mortality have not been well investigated in Ethiopia. The objective of this study was to investigate the mortality trend, causes of death, and risk factors among children under 5 in Ethiopia during 1990–2013.MethodsWe used Global Burden of Disease (GBD) 2013 data. Spatiotemporal Gaussian Process Regression (GPR) was applied to generate best estimates of child mortality with 95% uncertainty intervals (UI). Causes of death by age groups, sex, and year were measured using Cause of Death Ensemble modeling (CODEm). For estimation of HIV/AIDS mortality rate, the modified UNAIDS EPP-SPECTRUM suite model was used.ResultsBetween 1990 and 2013 the under-5 mortality rate declined from 203.9 deaths/1000 live births to 74.4 deaths/1000 live births with an annual rate of change of 4.6%, yielding a total reduction of 64%. Similarly, child (1–4 years), post-neonatal, and neonatal mortality rates declined by 75%, 64%, and 52%, respectively, between 1990 and 2013. Lower respiratory tract infection (LRI), diarrheal diseases, and neonatal syndromes (preterm birth complications, neonatal encephalopathy, neonatal sepsis, and other neonatal disorders) accounted for 54% of the total under-5 deaths in 2013. Under-5 mortality rates due to measles, diarrhea, malaria, protein-energy malnutrition, and iron-deficiency anemia declined by more than two-thirds between 1990 and 2013. Among the causes of under-5 deaths, neonatal syndromes such as sepsis, preterm birth complications, and birth asphyxia ranked third to fifth in 2013.Of all risk-attributable deaths in 1990, 25% of the total under-5 deaths (112,288/435,962) and 48% (112,288/232,199) of the deaths due to diarrhea, LRI, and other common infections were attributable to childhood wasting. Similarly, 19% (43,759/229,333) of the total under-5 deaths and 45% (43,759/97,963) of the deaths due to diarrhea and LRI were attributable to wasting in 2013. Of the total diarrheal disease- and LRI-related deaths (n = 97,963) in 2013, 59% (57,923/97,963) of them were attributable to unsafe water supply, unsafe sanitation, household air pollution, and no handwashing with soap.ConclusionsLRI, diarrheal diseases, and neonatal syndromes remain the major causes of under-5 deaths in Ethiopia. These findings call for better-integrated newborn and child survival interventions focusing on the main risk factors.