Social determinants and child survival in Nigeria in the era of Sustainable Development Goals: Progress, challenges, and opportunities

Introduction: Like in many low- and middle-income settings, childhood mortality remains a big challenge in Nigeria—being the second largest contributor to under-five mortality globally, after India. Currently, there is little local evidence to guide policymakers in Nigeria to tailor appropriate social interventions to make the Sustainable Development Goal (SDG) targets of child survival (SDG-3), gender equality (SDG-5), and social inclusiveness (SDG-10) achievable by 2030. In addition, lack of methodological rigor and theoretical foundations of child survival research in Nigeria limit their use for proper planning of child health services. Aims: The basis of this thesis is to understand the complex issues relating to child survival and recommend new approaches to guide policymakers on interventions that will improve child survival in Nigeria. The overarching goal of this thesis is to address the methodological and theoretical shortcomings identified in the previous studies conducted in Nigeria. Using robust interdisciplinary analytic techniques, this thesis assessed the following specific objectives. Objective 1: (a) Compare predictive abilities of the most used conventional statistical time-series methods—ARIMA and Holt-Winters exponential smoothing models, with artificial intelligence technique such as group method of data handling (GMDH)-type artificial neural network (ANN), and (b) estimate the age- and sex-specific mortality trends in child-related SDG indicators (i.e., neonatal and under-five mortality rates) over the 1960s-2017 period, and estimate the expected annual reduction rates needed to achieve the SDG-3 targets by projecting rates from 2018 to 2030. Objective 2: (a) Identify the social determinants of age-specific childhood (0-59 months) mortalities, which are disaggregated into neonatal mortality (0-27 days), post-neonatal mortality (1-11 months) and child mortality (12-59 months), and (b) estimate the within- and between-community variations of mortality among under-five children in Nigeria. Objective 3: Identify the critical pathways through which social factors (at maternal, household, community levels) determine neonatal, infant, and under-five mortalities in Nigeria. Objective 4: (a) Determine patterns and determinants of geographical clustering of neonatal mortality at the state and regional levels in Nigeria, (b) assess gender inequity for neonatal mortality between urban and rural communities across the regions in Nigeria, and (c) measure gaps in SDG-3 target for neonatal mortality at the state and regional levels in Nigeria. Methods: This thesis is a quantitative study which used two secondary datasets—aggregated historical childhood mortality data from 1960s to 2017 (objective 1), and the latest (2016/2017) Nigeria Multiple Indicator Cluster Survey (MICS) for 36 states and Federal Capital Territory (FCT) in Nigeria (objectives 2-4). To minimize recall bias, analysis was limited to a weighted nationally representative sample of 30,960 live births delivered within five years before the survey. The selection of relevant social determinants of child survival was primarily informed by Mosley-Chen framework. The candidate variables were layered across child, maternal, household, and community-levels. The analytic approaches include artificial intelligence technique (i.e., group method of data handling (GMDH)-type artificial neural network, and multilayer perceptron (MLP) neural network), autoregressive integrated moving average (ARIMA), Holt-Winters exponential smoothing models, spatial cluster analysis, hierarchical path analysis with time-to-event outcome, and multilevel multinomial regression. Results: Progress towards achieving SDG targets – Nigeria is not likely to achieve SDG targets for child survival and, within, gender equity by 2030 at the current annual reduction rates (ARR) under-five mortality rate (U5MR): 1.2%, and neonatal mortality rate (NMR): 2.0%. If the current trend continues, U5MR will begin to increase by 2028. Also, at the end of SDG-era, female deaths will be higher than male deaths (80.9 vs. 62.6 deaths per 1000 live births). To make child-related SDG targets achievable by 2030, Nigeria needs to reduce annual U5MR by 9 times and annual NMR by 4 times the current rate of decrease. Social determinants of childhood mortality – At each stage of early childhood development, there are different factors relating to survival outcomes. Surprisingly, attendance of skilled health providers during delivery was associated with an increased neonatal mortality risk, although its effect disappeared during post-neonatal and toddler/pre-school stages. The observed association requires cautious interpretation because of unavailability of variables on quality of care in MICS dataset to assess how skilled birth delivery impacts child survival in Nigeria. However, there is a possibility of under-reporting under-five mortalities at the community level. Also, it could indicate a functioning referral system that sends the high-risk deliveries to health facilities to a greater extent. There is a large variation (39%) of under-five mortalities across the Nigerian communities, which is accounted for by maternal-level factors (i.e., maternal education, contraceptive use, maternal wealth, parity, death of previous children and quality of perinatal care). Pathways to childhood mortality – Region and area of residence (urban/rural), infrastructural development, maternal education, contraceptive use, marital status, and maternal age at birth were found to operate indirectly on neonatal, infant and under-five survival. Female children, singleton, children whose mothers delivered at least two years apart and aged 20-34 years survived much longer. Specifically, women from Northern areas of Nigeria were less likely to reside in urban cities and towns than those in the Southern areas. This, in turn, limited their access to social infrastructure and acted as a barrier to maternal education. Without adequate education, women were less likely to use contraceptive methods. Women with no history of contraceptive use were more likely to have childbirths closer together (less than two-year gap), which in turn, negatively impacted child survival. Regional inequities in childhood mortality – There was significant state-level clustering of NMR in Nigeria. The states with higher neonatal mortality rates were majorly clustered in the North-West and North-Central regions, and states with lower neonatal mortality rates were clustered in the South-South and South-East regions. Gender inequity was worse in the rural areas of Northern Nigeria, while it was worse in the urban areas of Southern Nigeria. NMR was disproportionately higher among females in urban areas (except North-West and South-West regions). Conversely, male neonates had higher mortality risks in the rural areas for all the regions. Conclusions: This thesis provides more refined age- and sex-specific mortality estimates for Nigeria. At the current rates, Nigeria will not meet SDG targets for child survival. In addition, this thesis identifies the critical intervention pathways to child survival in Nigeria during the SDG-era. The new estimates may be used to improve the design and accelerate the implementation of child health programmes to attain the SDG targets. Also, it is important for stakeholders to implement more impactful policies that promote maternal education and improve living conditions of women (especially in the rural areas). To address gender inequities, gender-sensitive policies, and community mobilization against gender-based discrimination towards girl-child should be implemented. Further research is required to assess the quality of skilled birth attendants in Nigeria

Intra-urban variation in tuberculosis and community socioeconomic deprivation in Lisbon metropolitan area: a Bayesian approach

Background: Multidrug resistant tuberculosis (MDR-TB) is a recognized threat to global efforts to TB control and remains a priority of the National Tuberculosis Programs. Additionally, social determinants and socioeconomic deprivation have since long been associated with worse health and perceived as important risk factors for TB. This study aimed to analyze the spatial distribution of non-MDR-TB and MDR-TB across parishes of the Lisbon metropolitan area of Portugal and to estimate the association between non-MDR-TB and MDR-TB and socioeconomic deprivation. Methods: In this study, we used hierarchical Bayesian spatial models to analyze the spatial distribution of notification of non-MDR-TB and MDR-TB cases for the period from 2000 to 2016 across 127 parishes of the seven municipalities of the Lisbon metropolitan area (Almada, Amadora, Lisboa, Loures, Odivelas, Oeiras, Sintra), using the Portuguese TB Surveillance System (SVIG-TB). In order to characterise the populations, we used the European Deprivation Index for Portugal (EDI-PT) as an indicator of poverty and estimated the association between non-MDR-TB and MDR-TB and socioeconomic deprivation. Results: The notification rates per 10,000 population of non-MDR TB ranged from 18.95 to 217.49 notifications and that of MDR TB ranged from 0.83 to 3.70. We identified 54 high-risk areas for non-MDR-TB and 13 high-risk areas for MDR-TB. Parishes in the third [relative risk (RR) = 1.281, 95% credible interval (CrI): 1.021–1.606], fourth (RR = 1.786, 95% CrI: 1.420–2.241) and fifth (RR = 1.935, 95% CrI: 1.536–2.438) quintile of socioeconomic deprivation presented higher non-MDR-TB notifications rates. Parishes in the fourth (RR = 2.246, 95% CrI: 1.374–3.684) and fifth (RR = 1.828, 95% CrI: 1.049–3.155) quintile of socioeconomic deprivation also presented higher MDR-TB notifications rates. Conclusions: We demonstrated significant heterogeneity in the spatial distribution of both non-MDR-TB and MDR-TB at the parish level and we found that socioeconomically disadvantaged parishes are disproportionally affected by both non-MDR-TB and MDR-TB. Our findings suggest that the emergence of MDR-TB and transmission are specific from each location and often different from the non-MDR-TB settings. We identified priority areas for intervention for a more efficient plan of control and prevention of non-MDR-TB and MDR-TB. Graphical Abstract: [Figure not available: see fulltext.] © 2022, The Author(s).This work has been funded by National funds, through the Foundation for Science and Technology (FCT)—project UIDB/50026/2020, UIDP/50026/2020 and PTDC/SAU-PUB/29521/2017. This study was also supported by FEDER through the Operational Programme Competitiveness and Internationalization and national funding through the Foundation for Science and Technology—FCT (Portuguese Ministry of Science, Technology and Higher Education) under the Unidade de Investigação em Epidemiologia—Instituto de Saúde Pública da Universidade do Porto (EPIUnit) (UIDB/04750/2020). Ana Isabel Ribeiro was supported by National Funds through FCT, under the programme of ‘Stimulus of Scientific Employment—Individual Support’ within the contract CEECIND/02386/2018

On metrics and financing for the Sustainable Development Goals

The world has experienced unprecedented growth in average per capita incomes over the last 50 years, but many countries continue to face deep economic, social, and/or environmental challenges. These include persistent extreme poverty, poor outcomes in human health and education, widespread malnutrition, high inequality measured by income or other characteristics, poor access to infrastructure, growing water stress, the degradation of terrestrial and marine ecosystems, pollution, and climate change. Under business-as-usual trajectories the environmental challenges in particular are expected to worsen significantly. Enhanced international policy coordination and cooperation around shared goals is required to reverse these trends, and many developing countries require more external financial assistance. In response governments have adopted international development goals, including the Millennium Development Goals (MDGs) and their successors, the Sustainable Development Goals (SDGs), which are to be achieved by 2030. These goals complement earlier tools for international policy coordination, notably the environmental conventions, such as the United Nations Framework Convention on Climate Change and the Convention on Biological Diversity. This thesis contributes to the need to understand how progress towards the SDGs can be monitored, how investment needs for climate-resilient development and the SDGs can be estimated, and what lessons can be drawn for international financing mechanisms in support of the SDGs from the experience of the health sector under the MDGs. These issues represent important contemporary questions in the scientific and policy literature, as evidenced by the rapidly growing scientific literature on the SDGs to which this thesis contributes. Chapter 2 introduces a novel SDG Index and Dashboards that combines official and science-based metrics to establish an SDG baseline for the 149 countries for which sufficient data are currently available. The SDG Index and Dashboards measure countries’ distance from achieving the goals, assess overall performance, and identify implementation priorities for each country. We find that many countries’ development models are imbalanced in favor of economic development and at the expense of social inclusion and environmental sustainability. We demonstrate the SDG Index’ usefulness as an explanatory variable in studying policy objectives, such as subjective well-being and in identifying policy priorities. Moreover, the chapter identifies major data gaps for monitoring the SDGs and suggests ways in which these can be closed in coming years. In Chapter 3 we consider the combined investment needs of development objectives in low-income country settings, as exemplified by the MDGs, and measures to adapt to a changing climate. Drawing on consensus investment needs for the MDGs in Africa, as established by the MDG Africa Steering Group, and the literature on investment needs for climate change adaptation, we propose and apply a methodology for integrating these assessments. The chapter reviews major line items in financing the MDGs and considers the nature and extent of additional measures to adapt to climate change, as well as associated financing needs. We find that climate change adaptation may increase total investment needs by some 40 percent. The analysis shows that development and adaptation measures need to be integrated along sectoral lines in order to facilitate implementation by governments. Chapter 4 extends this analysis to propose an analytical framework for SDG needs assessments that translates the 17 SDGs into eight investment areas and introduces a preliminary score to assess the quality and suitability of needs assessment studies. Using this framework, published sector needs assessments are analyzed, harmonized, and consolidated to arrive at a first assessment of private and public investment needs for the SDGs in low- and lower-middle-income countries. Incremental spending needs in these countries are estimated at $1.3-1.4 trillion per year. Approximately half of these incremental investments can be privately financed. Domestic resource mobilization can increase significantly, leaving an external financing gap of perhaps$152-163 billion per year (equivalent to 0.22-0.26% of high-income countries’ GDP) that must be met through international public finance, including Official Development Assistance. Globally, an incremental 1.5-2.5% of world GDP needs to be invested each year by the public and private sectors to achieve the SDGs in every country. Turning to the financing of the SDGs, Chapter 5 investigates the experience of the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria in financing the rapid scaling up of proven health interventions observed since 2002. The chapter identifies 8 key design principles of the Global Fund that set the institution apart from other multilateral financing mechanisms. It then considers to what extent these design principles have enabled rapid progress in combating the three infectious diseases in a broad range of operating environments, including fragile countries and countries with poor governance. The chapter concludes that the Global Fund has performed better than expected at inception, and that the key design principles explain this success. Adopting these principles may help multilateral grant financing mechanisms focusing on other SDG priorities – such as education; access to energy, water, and sanitation; nutrition; and smallholder agriculture – improve the effectiveness of resource use and accelerate progress towards the goals. In the Chapter 6, we investigate the Global Fund’s Technical Review Panel (TRP) to determine whether it had succeeded in reconciling the competing needs of country ownership of development programs and the need to ensure effective use of scarce resources. We also investigate whether the demand-based application process generated funding allocations that were in line with the Global Fund’s objective to direct funds towards the countries most in need. To answer these questions, we construct a novel dataset and conduct four sets of regression analysis using ordinary least squares and ordered logistic regression models. The chapter finds that the TRP operated in line with the Global Funds’ objectives and allocated funding to countries most in need, though we find evidence that countries with large populations suppressed the volume of financing requested from the Global Fund. The evidence suggests that the TRP promoted learning on how to scale up disease control programs and that the Global Fund operated equally well across different country environments, including fragile and poorly governed countries. The chapter closes by considering the policy implications for financing the SDGs in health and other areas. The concluding chapter summarizes the research findings and critically discusses the methodologies and data used in this thesis. It outlines suggestions for further research and summarizes policy implications for monitoring, implementing, and financing the SDGs.</p

Open Mapping towards Sustainable Development Goals

This collection amplifies the experiences of some of the world’s young people who are working to address SDGs using geospatial technologies and multi-national collaboration. Authors from every region of the world who have emerged as leaders in the YouthMappers movement share their perspectives and knowledge in an accessible and peer-friendly format. YouthMappers are university students who create and use open mapping for development and humanitarian purposes. Their work leverages digital innovations - both geospatial platforms and communications technologies - to answer the call for leadership to address sustainability challenges. The book conveys a sense of robust knowledge emerging from formal studies or informal academic experiences - in the first-person voices of students and recent graduates who are at the forefront of creating a new map of the world. YouthMappers use OpenStreetMap as the foundational sharing mechanism for creating data together. Authors impart the way they are learning about themselves, about each other, about the world. They are developing technology skills, and simultaneously teaching the rest of the world about the potential contributions of a highly connected generation of emerging world leaders for the SDGs. The book is timely, in that it captures a pivotal moment in the trajectory of the YouthMappers movement’s ability to share emerging expertise, and one that coincides with a pivotal moment in the geopolitical history of planet earth whose inhabitants need to hear from them. Most volumes that cover the topic of sustainability in terms of youth development are written by non-youth authors. Moreover, most are written by non-majoritarian, entrenched academic scholars. This book instead puts forward the diverse voices of students and recent graduates in countries where YouthMappers works, all over the world. Authors cover topics that range from water, agriculture, food, to waste, education, gender, climate action and disasters from their own eyes in working with data, mapping, and humanitarian action, often working across national boundaries and across continents. To inspire readers with their insights, the chapters are mapped to the United Nations 17 Sustainable Development Goals (SDGs) in ways that connect a youth agenda to a global agenda. With a preface written by Carrie Stokes, Chief Geographer and GeoCenter Director, United States Agency for International Development (USAID). This is an open access book

Bridging the financial and academic gap in key Sustainable Development Goal(s): comprehensive bibliometric analysis

Три найбільш часто згадувані Цілі сталого розвитку в наукових дослідженнях: Ціль сталого розвитку 3 Добре здоров’я та добробут (2 173 321 публікацій), Ціль сталого розвитку 7 Доступна та чиста енергія (711 226) та Ціль сталого розвитку 9: Промисловість, інновації та інфраструктура (378,55 публікацій). У цій монографії представлено вичерпний бібліометричний метааналіз Цілей сталого розвитку 3, 7 та 9 у вирішенні проблеми фінансування цих Цілей.Три наиболее часто упоминаемые Цели устойчивого развития в научных исследованиях: Цель устойчивого развития 3 Хорошее здоровье и благополучие (2 173 321 публикаций), Цель устойчивого развития 7 Доступная и чистая энергия (711 226) и Цель устойчивого развития 9: Промышленность, инновации и инфраструктура (378,55 публикаций). В этой монографии представлен исчерпывающий библиометрический метаанализ Целей устойчивого развития 3, 7 и 9 в решении проблемы финансирования этих Целей.The three most frequently mentioned goals in the academic research are Sustainable Development Goal 3 Good Health and Well Being (2,173,321 publications), Sustainable Development Goal 7 Affordable and Clean Energy (711,226) and Sustainable Development Goal 9: Industry, innovation and infrastructure (378,553 publications). This monograph provides a comprehensive bibliometric meta-analysis of the most popular among academicians Sustainable Development Goals 3, 7 and 9 in solving the problem of these Goals financing

Open Mapping towards Sustainable Development Goals

This collection amplifies the experiences of some of the world’s young people who are working to address SDGs using geospatial technologies and multi-national collaboration. Authors from every region of the world who have emerged as leaders in the YouthMappers movement share their perspectives and knowledge in an accessible and peer-friendly format. YouthMappers are university students who create and use open mapping for development and humanitarian purposes. Their work leverages digital innovations - both geospatial platforms and communications technologies - to answer the call for leadership to address sustainability challenges. The book conveys a sense of robust knowledge emerging from formal studies or informal academic experiences - in the first-person voices of students and recent graduates who are at the forefront of creating a new map of the world. YouthMappers use OpenStreetMap as the foundational sharing mechanism for creating data together. Authors impart the way they are learning about themselves, about each other, about the world. They are developing technology skills, and simultaneously teaching the rest of the world about the potential contributions of a highly connected generation of emerging world leaders for the SDGs. The book is timely, in that it captures a pivotal moment in the trajectory of the YouthMappers movement’s ability to share emerging expertise, and one that coincides with a pivotal moment in the geopolitical history of planet earth whose inhabitants need to hear from them. Most volumes that cover the topic of sustainability in terms of youth development are written by non-youth authors. Moreover, most are written by non-majoritarian, entrenched academic scholars. This book instead puts forward the diverse voices of students and recent graduates in countries where YouthMappers works, all over the world. Authors cover topics that range from water, agriculture, food, to waste, education, gender, climate action and disasters from their own eyes in working with data, mapping, and humanitarian action, often working across national boundaries and across continents. To inspire readers with their insights, the chapters are mapped to the United Nations 17 Sustainable Development Goals (SDGs) in ways that connect a youth agenda to a global agenda. With a preface written by Carrie Stokes, Chief Geographer and GeoCenter Director, United States Agency for International Development (USAID). This is an open access book

Estimation of subnational tuberculosis burden: generation and application of a new tool in Indonesia.

SETTING: In many high tuberculosis (TB) burden countries, there is substantial geographical heterogeneity in TB burden. In addition, decisions on TB funding and policy are highly decentralised. Subnational estimates of burden, however, are usually unavailable for planning and target setting.OBJECTIVE and DESIGN: We developed a statistical model termed SUBsET to estimate the distribution of the national TB incidence through a weighted score using selected variables, and applied the model to the 514 districts in Indonesia, which have substantial policy and budgetary autonomy in TB. Estimated incidence was compared to reported facility and domicile-based notifications to estimate the case detection rate (CDR). Local stakeholders led model development and dissemination.RESULTS: The final SUBsET model included district population size, level of urbanisation, socio-economic indicators (living floor space and high school completion), human immunodeficiency virus prevalence and air pollution. We estimated district-level TB incidence to be between 201 and 2,485/100 000/year. The facility-based CDR varied between 0 and 190%, with high variation between neighbouring districts, suggesting strong cross-district health utilisation, which was confirmed by domicile-based CDR estimation. SUBsET results informed district-level TB action plans across Indonesia.CONCLUSION: The SUBsET model could be used to estimate the subnational burden in high-burden countries and inform TB policymaking at the relevant decentralised administrative level

Innovation and Evidence for Achieving TB Elimination in the Asia–Pacific Region

The World Health Organization’s (WHO) END-TB strategy has set the world on course to climb the highest of medical mountains by 2035, with a targeted peak of reductions in TB deaths by 95%, TB cases by 90%, and no burdens of catastrophic expenses on families due to TB. Eliminating TB in the Asia-Pacific region, which has 62% of all estimated TB patients globally, will require innovation, rigorous research, and sustained investment. This special issue connects original research and viewpoints on pertinent approaches for improving TB care and prevention in the Asia-Pacific region