Under-five Mortality Research Articles

Determinants of under-five mortality in Zimbabwe: Evidence from the 2015–2016 Zimbabwe demographic Health Survey data

BackgroundChild mortality is an important measure of a population’s health status. It is included in the third sustainable development goal that aims to improve global health by reducing under-five mortality to at least as low as 25 per 1000 live births by 2030. The study determines the factors associated with under-five child mortality in Zimbabwe. MethodsCross-sectional secondary data from the 2015 Zimbabwe Demographic Health Survey (ZDHS) were analyzed. The sample included 5,806 women aged 15–49 years of reproductive age. The Chi-square test was used to analyze the association between child death and independent variables. We identified the individual and contextual factors associated with child deaths in Zimbabwe using the Cox proportional hazard model. ResultsThe risks of under-five mortality were highest among children of first birth order (adjusted hazard ratio (aHR) ​= ​2.37, P ​= ​0.04), multiple births (aHR ​= ​2.37, P= 0.04), mothers with primary or less maternal education (aHR ​= ​1, Ref), mothers below 18 years old (aHR ​= ​1, Ref), apostolic mothers (aHR ​= ​2.90, P= 0.002), mothers who do not use contraceptives (aHR ​= ​2.20, P ​< ​0.001), formerly married women (aHR ​= ​6.42, P= 0.005), women with 5 or more children (aHR ​= ​15.84, P ​< ​0.001), women who read newspapers less than once a week (aHR ​= ​1.75, P= 0.13), and households that use high-polluting fuels (aHR ​= ​1.92, P= 0.023). ConclusionThis study establishes that child health, maternal, socioeconomic, household, and ecological factors are important determinants of under-five mortality in Zimbabwe. Understanding these determinants is crucial for designing effective interventions and policies to reduce child mortality rates. This requires comprehensive approaches such as improving access to healthcare, education, and basic sanitation facilities; prioritizing nutrition; providing clean water; enhancing poverty reduction and immunization; and promoting breastfeeding and social empowerment, with a particular focus on vulnerable populations and marginalized communities.

ANALISIS PENGARUH FAKTOR RISIKO PENYAKIT PNEUMONIA TERHADAP ANGKA MORTALITAS BAYI DAN BALITA MENGGUNAKAN REGRESI POISSON DAN REGRESI BINOMIAL NEGATIF (Studi Kasus : Provinsi Jawa Barat)

Pneumonia is an acute infectious disease that attacks lungs caused by viruses, bacteria or fungi. This infection can be life-threatening for anyone, especially infants, children and people aged 65 years. In 2020 in West Java Province infant and toddler deaths due to pneumonia reached 122 cases. This study aims to analyze the factors that influence infant and under-five mortality rates by comparing Poisson regression and negative binomial regression, as well as modeling significant factors. The handling of overdispersion cases in Poisson regression can be done with alternative methods, one of which is the negative binomial regression method. This study uses secondary data obtained from the Health Profile of West Java Province 2020. The results of the study show that negative binomial regression handles overdispersion cases in data on the number of infant and under-five deaths due to pneumonia in West Java Province in 2020. Factors that influence infant mortality rates and toddlers due to pneumonia are low birth weight babies (X2) and population density (X4).

Under-five mortality before and after implementation of the Liberia National Community Health Assistant (NCHA) program: A study protocol.

Between 2018 and 2022 the Liberian Government implemented the National Community Health Assistant (NCHA) program to improve provision of maternal and child health care to underserved rural areas of the country. Whereas the contributions of this and similar community health worker (CHW) based healthcare programs have been associated with improved process measures, the impact of a governmental CHW program at scale on child mortality has not been fully established. We will conduct a cluster sampled, community-based survey with landmark event calendars to retrospectively assess child births and deaths among all children born to women in the Grand Bassa District of Liberia. We will use a mixed effects Cox proportional hazards model, taking advantage of the staggered program implementation in Grand Bassa districts over a period of 4 years to compare rates of under-5 child mortality between the pre- and post-NCHA program implementation periods. This study will be the first to estimate the impact of the Liberian NCHA program on under-5 mortality.

Drivers of success: improving implementation research tools for better health outcomes.

A thorough examination of context, and how it influences implementation of evidence-based interventions, is a promising strategy for enhancing child survival initiatives. Spreading approaches that are identified as drivers of successful reduction in under-five mortality from 'exemplar' countries could be pivotal in leading to reductions in other settings facing stagnant mortality rates, in particular for low- and middle-income countries with high disease burden and insufficient programmatic capacity to effectively implement evidence-based interventions at scale. Yet there remains a lack of robust analytic methods to accurately assess mortality and describe the drivers of interventions' implementation success at both national and subnational levels. The field of implementation science and its defining targets and tools is well positioned to address this knowledge gap by integrating qualitative and quantitative research methods into an adaptable evaluation framework that can be tailored to meet the specific needs across varying country contexts. These tools enhance the measurement of population health outcomes and provide crucial evidence on implementation barriers and facilitators that can inform policies that can be adjusted for diverse contexts. This commentary aims to emphasize the role of implementation research in understanding how exemplar countries achieved significant improvements in child survival and in identifying replicable lessons for other settings. Ultimately, all manuscripts underscore the relevance of implementation research in bolstering the reduction of under-five mortality.

Assessing Impediments to Healthcare Access for Children Under Five in Larkana, Pakistan Using the Three Delays Model

Abstract:&#x0D; Background: Despite national improvements, Larkana district in Pakistan suffers from high under-five child mortality. This study employs the Three Delays Model (TDM) to identify impediments to healthcare access for children under five in Larkana, informing interventions to combat preventable deaths.&#x0D; Methods: A cross-sectional survey (January-April 2021) in Larkana hospitals recruited 390 parents/guardians via simple random sampling. Semi-structured interviews explored sociodemographics, care-seeking behaviors, and barriers across the TDM's three delays: 1) recognizing and acting on illness, 2) reaching care, and 3) receiving adequate care. Data was analyzed in SPSS v22 using frequencies, percentages, and chi-square tests for associations between sociodemographic factors and care-seeking patterns.&#x0D; Results: 47% of mothers and 29% of fathers lacked formal education. 49.7% of children were born at home. Delay 1 barriers included preference for traditional healers (36%). Delay 2 barriers included lack of transportation (17%) and long travel times (&gt;3 hours for 84%). Delay 3 barriers included high healthcare costs (43% spending &gt;1000 rupees). Illiterate mothers predominantly gave birth at home (44% vs. 13% matriculate mothers, p&lt;0.001) and were less likely to recognize danger signs (61% vs. 89%, p&lt;0.001). Rickshaws were the primary mode of transport (86%).&#x0D; Discussion: This TDM-based study reveals multiple intertwined barriers hindering child healthcare access in Larkana. Maternal education significantly influences care-seeking behavior and danger sign recognition, highlighting the need for targeted community education programs. High prevalence of home births necessitates interventions promoting institutional deliveries. Lack of transportation and high costs demand affordable options like government-subsidized transport or expanded health insurance coverage.&#x0D; Keywords: child health, access to care, Pakistan

Embedded implementation research in programming at scale - the new normal to be!

If you want to run faster, don't just buy a new pair of shoes; also consider your training methods and where you run.This supplement examines six countries that have run faster than others in reducing under-five mortality, taking an implementation research approach, with country case studies done with local researchers and local institutions. Key generalizable learnings are to choose and adapt implementation strategies to context, design strategies to target the most vulnerable, systematically learn from implementation experience, and to leverage non-health-sector contributions.Embedding implementation research in programming has the potential to greatly improve and accelerate the contextualization and implementation of evidence-based child survival interventions to improve equity in coverage and overall effectiveness in reducing under-five mortality. It is now time to build such capacity in local institutions at scale, and incentives for concerned stakeholders to make this the new normal. Regional institutions should now take the lead in making this happen, not just in individual institutions and countries, but across entire regions, supported by global partners.Trial registrationN/A.

Health policy competencies in regional organizations: a retrospective analysis for 76 regional organizations from 1945 to 2015

BackgroundHealth policy competencies of regional organizations include mandates to create regional health laws and policies, as well as authorities that allow member states to undertake collective actions in the health field. The examination of the health policy competencies of regional organizations is essential, as it constitutes an important prerequisite for regional organizations to govern regional health. This study aims to map the development trajectory of health policy competencies in regional organizations worldwide and investigate their potential correlates. This will contribute to the enhanced promotion of both existing and new regional health cooperation.MethodsThis retrospective analysis utilized the health policy competencies of the 76 regional organizations worldwide from 1945 to 2015, as investigated in the Regional Organizations Competencies Database. By aggregating member state data from various sources such as the IHME Global Burden of Disease 2019, the World Bank, and the World Trade Organization, we extracted the mean values and coefficients of variation for the covariates in regional organization characteristics, socioeconomic and demographic factors, health status and health-system capacity. The correlation between changes in the health policy scope of regional organizations and independent variables was analyzed using Poisson pseudo-likelihood regression with multiple levels of fixed effects.ResultsFrom 1945 to 2015, the number of regional organizations with health policy competencies experienced a slow growth stage before 1991 and an explosive growth stage post-1991. By 2015, 48 out of the 71 existing regional organizations had developed their health policy competencies, yet 26 (54.2%) of these organizations possessed only 1–2 health policy competencies. An enhancement in the health policy scope of a regional organization correlated with its founding year, a greater number of policy fields, higher under-five mortality, and larger disparities in trade and healthcare access and quality indexes among member states. In contrast, larger disparities in population, under-five mortality and health worker density among member states, along with more hospital beds per capita, were negatively correlated with the expansion of a regional organization’s health policy scope.ConclusionSince 1991, there has been a surge of interest in health among regional organizations, although health remains a secondary priority for them. The health policy competencies of regional organizations are pivotal for promoting social equity within regional communities. Its establishment is also closely linked to the level and disparities among member states in aspects such as trade, population, child mortality rates, and health system capacity.

Stress Ibu Selama Kehamilan Merupakan Risiko Persalinan Prematur

Under-five mortality in Southeast Sulawesi province is estimated to be more than 50% due to the risk of LBW, asphyxia, pneumonia, diarrhea and congenital abnormalities. The incidence of LBW with the most cases was found in South Konawe District with 266 infants out of a total of 5,796 births. The purpose of the study was to determine the causative factors of preterm labor at the South Konawe District Hospital, this research method is quantitative with an observational approach using a Case Control Study design, this research was conducted from February to March 2023 at the South Konawe District Hospital with a total sample of 116 respondents. The sampling technique for the condition group (Premature Labor) carried out in this study used a probability sample, namely Simple random sampling. The results of the study showed that stress has a risk of 11.22 times the incidence of preterm labor in South Konawe District Hospital. It is concluded that stress in pregnant women is a risk factor for preterm labor.

Time to death and its predictors among Ethiopian under-five children: cluster-level shared frailty survival analysis using the 2019 Ethiopian mini demographic health survey

Introduction: Reducing under-five mortality to less than 25 per 1000 live births by 2030 is one of the Sustainable Development Goals introduced in 2016. However, several countries are still falling short of their targets. In Ethiopia, one out of every 19 children dies before reaching the age of five. Thus, this study aims to identify the time to death and its predictors among under-five children in Ethiopia. Methods: The data were retrieved from the 2019 Ethiopian Mini Demographic and Health Survey data set. Descriptive statistics and survival curves were applied. Shared frailty survival analysis was employed to determine the predictors of under-five mortality. Statistical significance was declared at p-value &lt;0.05. Result: The under-five mortality rate was found to be 59 deaths per 1000 live births with an estimated mean survival time of 57.6 months (95%CI: 57.38, 57.85). A child born into a family of seven or more had an 85% lowered risk of dying (AHR = 0.15, 95% CI: 0.05, 0.44). The risk of mortality among children born in the birth order of five or above was 3 times higher (AHR = 3.00, 95%CI: 1.70, 5.21) compared to those born in the birth order of one to four. The estimated risk of death among under-five children born less than 24 months interval was 2.68 times higher (AHR=2.68, 95%CI: 1.71, 4.21). Never breastfed was also a significant predictor of under-five child death (AHR = 2.76, 95%CI: 1.46, 5.23). Conclusion: Birth order, family size, preceding birth interval, and never breastfed history were significant predictors of under-five child mortality. Health policies should focus on keeping the spirit of a continuum of care to improve the health of the child and the health of the family as a whole. Health care providers should intervene in the community to maximize optimal infant and young child feeding practices.

Under-five Mortality: Comparative Study of Kenya and other three East-african Developing Countries

Background An indicator called the under-five mortality rate makes it possible to compare deaths in several locations and groups of children of various sizes at once. Sub-Saharan Africa (SSA) still has a high under-five mortality rate that needs to be addressed before modifiable causes can be completely recognized. Objective The study investigates the stark disparity in mortality rates for children under five between Kenya, Rwanda, Tanzania, and Uganda. Methods The study assessed secondary data from the World Bank repository covering four East African nation's period from 1990 to 2019. Kruskal-Wallis One-way ANOVA was used in the study as a method of data analysis. Therefore, A significance threshold of 0.05 is therefore, considered for the statistical tests in this investigation, and the statistical software used is R. Results The findings showed that the under-five mortality rates of the four nations under consideration differed significantly (p&lt;0.05). The median under-five mortality for the country Kenya was 82 compared to 117 in Rwanda, Uganda was 113, while for Tanzania was 97. According to a Wilcoxon signed rank pairwise tests, there is a significant difference in under-five mortality between Kenya and Uganda. Conclusion Kenya has the lowest average under-five mortality rate (79.00 ± 26.40), while Rwanda has the highest average rate (123.53 ± 72.93). Within the review period, the average mortality rate in Rwanda was 40 higher than the average in Kenya and more than 20 more than the average for Tanzania's under-five mortality rate.

Health Infrastructure and Economic Development Nexus in Nigeria

Nigeria like many other Sub-Saharan African countries has been plagued with lack of functional infrastructure in order to grow the economy. Recent events in Nigeria, such as the COVID-19 pandemic, which emerged in late 2019 and continues to impact Nigeria, has exposed the vulnerabilities and weaknesses in the country's health infrastructure. This study investigates the impact of health infrastructure on economic development in Nigeria. The study employed time series data. Health infrastructure was captured by government recurrent and capital expenditure on health while economic development was proxied by per capita gross national product. The Autoregressive Distributive Lag (ARDL) estimation technique was used to establish the long run relationship among the variables. It was revealed that long run relationship exists among the variables in the estimated model. The results of the Error Correction Mechanism (ECM) within the framework of the ARDL shows that health infrastructure has significant impact on economic development in Nigeria. The study concludes that health infrastructure plays key roles in influencing economic development in Nigeria, and for the optimal performance of the economy, the government must increase infrastructural spending on health care in order to reduce the rate of maternal, infant and under-five mortality in the country. The study recommends that; there is a need for the government at all levels to massively invest in the provision of health infrastructure which is a strong viable means of reducing mortality incidence and enhancing economic development in Nigeria. Nigeria’s share of government expenditure to the health sector ranges between 5-7 percent, which falls immensely below the minimum standard of 16 percent as recommended by UNESCO for a developing country, which calls for emergency intervention in the health sect

A retrospective analysis of malaria deaths in the pre- and intra- COVID 19 pandemic era, Ghana, 2016-2021.

Global efforts over the years have resulted in a 27% reduction in malaria incidence and an estimated 51% reduction in malaria mortality since 2000. Meanwhile, COVID-19 pandemic disrupted provision and utilization of malaria services, leading to a surge in malaria incidence and mortality. Globally, 627000 malaria deaths were recorded in 2020, representing about 69000 more deaths compared to 2019. Also, 14 million more cases of malaria were recorded in 2020 compared to 2019. This study sought to determine whether excess malaria deaths were recorded in Ghana during the COVID-19 pandemic era. This was a descriptive study on routine malaria mortality data in Ghana for the period 2016 to 2021. Data was retrieved from the District Health Information Management System using a data extraction guide. Excess mortality was defined as occurrence of malaria deaths more than expected value for the period 2020 and 2021. The expected number of mortalities for 2020 and 2021 were determined using 2016 to 2019 average. Excess mortality (P-score) was estimated using the formula: [(reported mortalities-expected mortalities)/expected mortalities X 100%]. Data were summarized and processed in Microsoft excel version 16.0. Malaria mortality in Ghana and its regions was described using tables and line graphs. An average of 535 malaria deaths per year were recorded nationwide from 2016 to 2020. About 50% (1603/3207) of deaths occurred in children aged less than five years. The p-scores for the country were -53% and -58% for 2020 and 2021 respectively. No region recorded excess all-age malaria mortality in 2020, rather significant reduction. Stratified by age, Greater Accra region reported 90% higher than expected deaths among persons aged five years and above in 2020 (p-score = 90%, 95% CI: 21-159). All regions reported reduction in under-five mortality in 2020. No significant excess malaria mortalities were reported among the regions in 2021. Although negative p-scores suggested a decline in malaria mortalities nationwide, some regions recorded excess deaths during the COVID-19 pandemic era. There is a need to integrate COVID-19 control activities with malaria control and prevention efforts to mitigate the impact of COVID-19 on malaria case management and mortality.

Identifying determinants of under-five child mortality in northern Togo.

Although global rates of under-five mortality have declined, many low- and middle-income countries (LMICs), including Togo, have not achieved sufficient progress. We aimed to identify the structural and intermediary determinants associated with under-five mortality in northern Togo. We collected population-representative cross-sectional household surveys adapted from the Demographic Household Survey (DHS) and Multiple Indicator Cluster Survey from women of reproductive age in northern Togo in 2018. The primary outcome was under-five mortality for children born to respondents in the 10-year period prior to the survey. We selected structural and intermediary determinants of health from the World Health Organization Conceptual Framework for Action on the Social Determinants of Health. We estimated associations between determinants and under-five mortality for births in the last 10 years (model 1 and 2) and two years (model 3) using Cox proportional hazards models. Of the 20 121 live births in the last 10 years, 982 (4.80%) children died prior to five years of age. Prior death of a sibling (adjusted hazard ratio (aHR) = 5.02; 95% confidence interval (CI) = 4.23-5.97), maternal ethnicity (i.e. Konkomba, Temberma, Lamba, Losso, or Peul), multiple birth status (aHR = 2.27; 95% CI = 1.78-2.90), maternal age under 25 years (women <19 years: aHR = 2.05; 95% CI = 1.75-2.39; women 20-24 years: aHR = 1.48; 95% CI = 1.29-1.68), lower birth interval (aHR = 1.51; 95% CI = 1.31-1.74), and higher birth order (second or third born: aHR = 1.45; 95% CI = 1.32-1.60; third or later born: aHR = 2.14; 95% CI = 1.74-2.63) were associated with higher hazard of under-five mortality. Female children had lower hazards of under-five mortality (aHR = 0.80; 95% CI = 0.73-0.89). Under-five mortality was also lower for children born in the last two years (n = 4852) whose mothers received any (aHR = 0.48; 95% CI = 0.30-0.78) or high quality (aHR = 0.51; 95% CI = 0.29-0.88) prenatal care. Compared to previous DHS estimates, under-five mortality has decreased in Togo, but remains higher than other LMICs. Prior death of a sibling and several intermediary determinants were associated with a higher risk of mortality, while receipt of prenatal care reduced that risk. These findings have significant implications on reducing disparities related to mortality through strengthening maternal and child health care delivery.

Health Problems Among Under-Five Age Group Children in Developing Countries: A Narrative Review.

The under-five age group is a crucial time for development because children's quick mental, physical, and socio-emotional aspects serve as the "building blocks" for their future development. The issue of child health is multifaceted, with certain regions, especially developing nations, experiencing an alarming rise in under-five children morbidity and mortality rates. Progress in reducing these rates in developing countries lags behind that of developed nations. Disparities in children's survival rates are pronounced worldwide, with developing nations bearing a disproportionate burden. Key contributors to child fatalities include malnutrition, respiratory infections, diarrheal diseases, measles, malaria, and neonatal complications. Extensive research utilizing prominent databases like PubMed and Google Scholar has been undertaken to explore this topic. Vaccination, adequate home care, access to medical services, and improved dietary practices emerge as crucial strategies for preventing many child fatalities. This review aims to delve into the underlying causes of illnesses and deaths among children under the age of five in developing nations.

Risk Factor of Paediatric Community-Acquired Pneumonia in Wajo Regency, Indonesia

Background: Pneumonia is the second highest cause of under-five mortality in Indonesia. This study aimed to analyse the risk factors for pneumonia among under-fives in Wajo Regency. Methodology: This type of research was a quantitative study using a case-control study design. The population was all children in the working areas of Salewangeng Health Centre, Penrang Health Centre, and Belawa Health Centre. The sample size was 224 children consisting of 112 cases and 112 controls. The odds ratio test and logistic regression were used to evaluate the data. Results: Risk factors associated with pneumonia were under-five nutritional status (OR=3.563; 95%CI=1.57-8.65; p=0.0008), indoor smoke exposure (OR=5.852; 95%CI=2.88-12.36; p=0.000), maternal age (OR=2.575; 95%CI=1.45-4.58; p=0.0005), and number of children in the family (OR=3.133; 95%CI=1.65-6.05; p=0.0002). Conclusions: The most influential risk factor for under-five pneumonia was indoor smoke exposure. The probability of pneumonia among under-fives who were exposed to indoor smoke, had a maternal age 30 years, and had poor nutritional status was 89.8%. It is recommended for the community to reduce smoking activities in the house and reduce the use of mosquito coils to prevent smoke exposure to children at home.

Preterm birth and neonatal mortality in selected slums in and around Dhaka City of Bangladesh: A cohort study.

Although under-five mortality has declined appreciably in Bangladesh over the last few decades, neonatal mortality still remains high. The objective of the study is to assess the level and determinants of preterm birth and the contribution of preterm birth to neonatal mortality. Data for this study came from selected slums in and around Dhaka city, where; since 2015, icddr,b has been maintaining the Health and Demographic Surveillance System (HDSS). The HDSS data were collected by female Field Workers by visiting each household every three months; however, during the visit, data on the Last Menstrual Period (LMP) were also collected by asking each eligible woman to ascertain the date of conception. Gestational age was estimated in complete weeks by subtracting LMP from the date of the pregnancy outcome. In this study, 6,989 livebirths were recorded by HDSS during 2016-2018, and these births were followed for neonatal survival; both bivariate and multivariate analyses were performed. Out of total births, 21.7% were born preterm (before 37 weeks of gestation), and sub-categories were: 2.19% for very preterm (28 to 31 weeks), 3.81% for moderate preterm (32 to 33 weeks), and 15.71% for late preterm (34 to 36 weeks). The study revealed that preterm babies contributed to 39.6% of neonatal deaths; however, the probability of death was very high on the 1st day of birth (0.124 for very preterm, 0.048 for moderate preterm, 0.024 for late preterm, and 0.013 for term birth), and continued until the 3rd day. In the regression analysis, compared to the term neonates, the odds of neonatal mortality were 8.66 (CI: 5.63, 13.32, p<0.01), 4.13 (CI: 2.69, 6.34, p<0.01) and 1.48 (CI: 1.05, 2.08, p<0.05) respectively for very, moderate, and late preterm birth categories. The population attributable fraction for neonatal mortality was 23%, and sub-categories were 14% for very preterm, 10% for moderate preterm, and 6% for late preterm. Although urban slums are in proximity to many health facilities, a substantial proportion of preterm births contribute to neonatal deaths. So, pregnant women should be targeted, to ensure timely care during pregnancy, delivery, and post-partum periods to improve the survival of new-borns in general and preterm birth in particular.

Geodetector analysis of individual and joint impacts of natural and human factors on maternal and child health at the provincial scale

This ecological study examined the individual and joint impacts of natural–human factors on the spatial patterns of maternal and child health status in China at the provincial scale in 2020. We considered natural factors (forest coverage, average temperature, and total sulfur dioxide and particulate matter emissions) and human factors (economic development, urbanization, healthcare access, and education level). We combined maternal, infant, and under-five mortality rates into a composite maternal and child health index using the entropy method. The spatial autocorrelation analysis of this index highlighted distinct health patterns across provinces, whereas the geodetector method assessed the effects of natural–human factors on the patterns. A notable east–central–west stepwise decline in health status was observed. Global Moran’s I showed positive spatial clustering, with high–high clustering areas in the Yangtze River Delta and low–low clustering areas in western regions. Factor detection identified eight significant natural–human factors impacting maternal and child health, with total sulfur dioxide emission density having the greatest impact. The interaction between average schooling years and total sulfur dioxide emission notably affected maternal and child health patterns. The study concludes that natural–human factors critically affect the spatial distribution of maternal and child health.

Does Public Financial Management Save Life? Evidence from a Quantitative Review of PFM and Health Outcomes in Sub-Saharan African Countries

ABSTRACT Public financial management (PFM) theory suggests that improvements in the allocation, execution, and monitoring of public funds can result in improved sectoral outcomes, including in health. However, the existing literature on the relationship between PFM quality and health outcomes provides limited empirical documentation and insufficient explanation of the mechanics of that relationship. This paper contributes to the literature by estimating the correlation between PFM quality and health outcomes from a sample of sub-Saharan African countries over the period 2005–2018, using a pooled ordinary least squares (OLS) estimator. The analysis uses Public Expenditure and Financial Accountability (PEFA) scores as proxies for PFM quality. The findings indicate that countries with high-quality PFM tended to have the lowest maternal, under-five and noncommunicable diseases (NCDs) mortality. Among the standard PFM dimensions, the one associated with the higher correlation with maternal and under-five mortality was “predictability and control in budget execution.” Better PFM quality was significantly associated with a drop in maternal and under-five mortality in countries which allocated a higher proportion of their budget to the health sector. In countries allocating a lower proportion of their budget to health, the correlations between PFM quality and the three mortality indicators were not significant. The negative correlations between PFM quality and maternal and under-five mortality were significant only in countries with more effective governance. These findings support an emphasis on strengthening PFM as a means of improving health service provision and health outcomes.

Predicting the potential impact of scaling up four pneumonia interventions on under-five pneumonia mortality: A prospective Lives Saved Tool (LiST) analysis for Bangladesh, Chad, and Ethiopia.

Pneumonia remains the leading cause of mortality in under-five children outside the neonatal period. Progress has slowed down in the last decade, necessitating increased efforts to scale up effective pneumonia interventions. We used the Lives Saved Tool (LiST), a modelling software for child mortality in low- and middle-income settings, to prospectively analyse the potential impact of upscaling pneumonia interventions in Bangladesh, Chad, and Ethiopia from 2023 to 2030. We included Haemophilus influenzae type B (Hib) vaccination, pneumococcal conjugate vaccine (PCV), oral antibiotics, pulse oximetry, and oxygen as pneumonia interventions in our analysis. Outcomes of interest were the number of pneumonia deaths averted, the proportion of deaths averted by intervention, and changes in the under-five mortality rate. We found that 19 775 lives of children under-five could be saved in Bangladesh, 76 470 in Chad, and 97 343 in Ethiopia by scaling intervention coverages to ≥90% by 2030. Our estimated reductions in pneumonia deaths among children under five range from 44.61% to 57.91% in the respective countries. Increased coverage of oral antibiotics, pulse oximetry, and oxygen show similar effects in all three countries, averting between 18.80% and 23.65% of expected pneumonia deaths. Scaling-up PCV has a prominent effect, especially in Chad, where it could avert 14.04% of expected pneumonia deaths. Under-five mortality could be reduced by 1.42 per 1000 live births in Bangladesh, 22.52 per 1000 live births in Chad, and 5.48 per 1000 live births in Ethiopia. This analysis shows the high impact of upscaling pneumonia interventions. The lack of data regarding coverage indicators is a barrier for further research, policy, and implementation, all requiring increased attention.

The effects of reproductive variables on child mortality in Ethiopia: evidence from demographic and health surveys from 2000 to 2016

BackgroundChild mortality is a crucial indicator reflecting a country's health and socioeconomic status. Despite significant global improvements in reducing early childhood deaths, Southern Asia and sub-Saharan Africa still bear the highest burden of newborn mortality. Ethiopia is one of five countries that account for half of new-born deaths worldwide.MethodsThis study examined the relationship between specific reproductive factors and under-five mortality in Ethiopia. A discrete-time survival model was applied to analyze data collected from four Ethiopian Demographic and Health Surveys (EDHS) conducted between 2000 and 2016. The study focused on investigating the individual and combined effects of three factors: preceding birth interval, maternal age at childbirth, and birth order, on child mortality.ResultsThe study found that lengthening the preceding birth interval to 18–23, 24–35, 36–47, or 48+ months reduced the risk of under-five deaths by 30%, 46%, 56%, and 60% respectively, compared to very short birth intervals (less than 18 months). Giving birth between the ages 20–34 and 35+ reduced the risk by 34% and 8% respectively, compared to giving birth below the age of 20. The risk of under-five death was higher for a 7th-born child by 17% compared to a 2nd or 3rd-born child. The combined effect analysis showed that higher birth order at a young maternal age increased the risk. In comparison, lower birth order in older maternal age groups was associated with higher risk. Lastly, very short birth intervals posed a greater risk for children with higher birth orders.ConclusionNot only does one reproductive health variable negatively affect child survival, but their combination has the strongest effect. It is therefore recommended that policies in Ethiopia should address short birth intervals, young age of childbearing, and order of birth through an integrated strategy.