Limited Progress in Increasing Coverage of Neonatal and Child-health Interventions in Africa and Asia

The study was conducted to analyze recent trends in the coverage of selected child-survival interventions. A systematic analysis of the coverage of six key child-health interventions in 29 African and Asian countries that had two recent demographic and health surveys—the latest one carried out in 2001 onwards and the immediately preceding survey conducted after 1990—was undertaken. A regression model was used for examining the relationship between the changes in the coverage of interventions and the changes in rates of mortality among children aged less than five years (under-five mortality). A limited increase in the coverage of key child-health interventions occurred in the past 5–10 years in these 29 countries in sub-Saharan Africa and Asia. More than half of the countries had no significant improvement or a significant reduction in the coverage of oral rehydration therapy (ORT) for diarrhoea (17/29) and care-seeking for acute respiratory infection (ARI) (16/29). Results of multivariate analysis revealed that increases in the coverage of early initiation of breastfeeding, ORT for diarrhoea, and care-seeking for ARI were significantly associated with reductions in under-five mortality. The results of this analysis should serve as a wake-up call for policy-makers and programme managers in countries, donors, and international agencies to accelerate efforts to increase the coverage of key child-survival interventions. The following three main actions are proposed: setting of the clear target; mobilization of resources for increasing skilled birth attendants and health workers trained in integrated management of childhood illness; and implementation of community-based approaches

Association between community management of pneumonia and diarrhoea in high-burden countries and the decline in under-five mortality rates: an ecological analysis

OBJECTIVE: The objective of the paper is to explore if the adoption of national policies to use community-based health providers for the management of pneumonia and diarrhoea is associated with the decline in under-five mortality, including achievement of the Millennium Development Goal (MDG)4 target, in high-burden countries. SETTING: This country level analysis covers 75 high-burden low-income and middle-income countries which accounted for 98% of the 5.9 million global under-five deaths in 2015. One-fourth of these deaths were due to pneumonia and diarrhoea. METHODS: χ2 tests and multiple regression analysis were used to examine the association between reduction in under-five mortality rates and community case management of pneumonia and diarrhoea by adjusting for the influence of other possible determinants. PARTICIPANTS: No patient or population interviewed/examined for this analysis. Countries were the unit of analysis. INTERVENTIONS: Community case management (CCM) of pneumonia and diarrhoea policies. Outcome measures Changes in under-five mortality rates over time. RESULTS: Countries that had adopted both CCM policies were three times more likely to achieve the MDG4 target than countries that did not have both policies in place. This association was further confirmed by the multivariate analysis (β-coefficient=10.4; 95% CI 2.4 to 18.5; p value=0.012). DISCUSSION: There is a statistically significant association between adoption of CCM policies for treatment of pneumonia and diarrhoea and the rate of decline in child mortality levels. It is important to promote CCM in countries lagging behind to achieve the new target of 25 or fewer deaths per 1000 live births by 2030

Global and regional estimates of cancer mortality and incidence by site: I. Application of regional cancer survival model to estimate cancer mortality distribution by site

BACKGROUND: The Global Burden of Disease 2000 (GBD 2000) study starts from an analysis of the overall mortality envelope in order to ensure that the cause-specific estimates add to the total all cause mortality by age and sex. For regions where information on the distribution of cancer deaths is not available, a site-specific survival model was developed to estimate the distribution of cancer deaths by site. METHODS: An age-period-cohort model of cancer survival was developed based on data from the Surveillance, Epidemiology, and End Results (SEER). The model was further adjusted for the level of economic development in each region. Combined with the available incidence data, cancer death distributions were estimated and the model estimates were validated against vital registration data from regions other than the United States. RESULTS: Comparison with cancer mortality distribution from vital registration confirmed the validity of this approach. The model also yielded the cancer mortality distribution which is consistent with the estimates based on regional cancer registries. There was a significant variation in relative interval survival across regions, in particular for cancers of bladder, breast, melanoma of the skin, prostate and haematological malignancies. Moderate variations were observed among cancers of colon, rectum, and uterus. Cancers with very poor prognosis such as liver, lung, and pancreas cancers showed very small variations across the regions. CONCLUSIONS: The survival model presented here offers a new approach to the calculation of the distribution of deaths for areas where mortality data are either scarce or unavailable

Data collection tools for maternal and child health in humanitarian emergencies: a systematic review

OBJECTIVE: To describe tools used for the assessment of maternal and child health issues in humanitarian emergency settings. METHODS: We systematically searched MEDLINE, Web of Knowledge and POPLINE databases for studies published between January 2000 and June 2014. We also searched the websites of organizations active in humanitarian emergencies. We included studies reporting the development or use of data collection tools concerning the health of women and children in humanitarian emergencies. We used narrative synthesis to summarize the studies. FINDINGS: We identified 100 studies: 80 reported on conflict situations and 20 followed natural disasters. Most studies (76/100) focused on the health status of the affected population while 24 focused on the availability and coverage of health services. Of 17 different data collection tools identified, 14 focused on sexual and reproductive health, nine concerned maternal, newborn and child health and four were used to collect information on sexual or gender-based violence. Sixty-nine studies were done for monitoring and evaluation purposes, 18 for advocacy, seven for operational research and six for needs assessment. CONCLUSION: Practical and effective means of data collection are needed to inform life-saving actions in humanitarian emergencies. There are a wide variety of tools available, not all of which have been used in the field. A simplified, standardized tool should be developed for assessment of health issues in the early stages of humanitarian emergencies. A cluster approach is recommended, in partnership with operational researchers and humanitarian agencies, coordinated by the World Health Organization

Limited Progress in Increasing Coverage of Neonatal and Child-health Interventions in Africa and Asia

The study was conducted to analyze recent trends in the coverage of selected child-survival interventions. A systematic analysis of the coverage of six key child-health interventions in 29 African and Asian countries that had two recent demographic and health surveys\u2014the latest one carried out in 2001 onwards and the immediately preceding survey conducted after 1990\u2014was undertaken. A regression model was used for examining the relationship between the changes in the coverage of interventions and the changes in rates of mortality among children aged less than five years (under-five mortality). A limited increase in the coverage of key child-health interventions occurred in the past 5-10 years in these 29 countries in sub-Saharan Africa and Asia. More than half of the countries had no significant improvement or a significant reduction in the coverage of oral rehydration therapy (ORT) for diarrhoea (17/29) and care-seeking for acute respiratory infection (ARI) (16/29). Results of multivariate analysis revealed that increases in the coverage of early initiation of breastfeeding, ORT for diarrhoea, and care-seeking for ARI were significantly associated with reductions in under-five mortality. The results of this analysis should serve as a wake-up call for policymakers and programme managers in countries, donors, and international agencies to accelerate efforts to increase the coverage of key child-survival interventions. The following three main actions are proposed: setting of the clear target; mobilization of resources for increasing skilled birth attendants and health workers trained in integrated management of childhood illness; and implementation of community-based approaches

The effect of Haemophilus influenzae type b and pneumococcal conjugate vaccines on childhood pneumonia incidence, severe morbidity and mortality

Background With the aim of populating the Lives Saved Tool (LiST) with parameters of effectiveness of existing interventions, we conducted a systematic review of the literature assessing the effect of Haemophilus influenzae type b (Hib) and pneumococcal (PC) conjugate vaccines on incidence, severe morbidity and mortality from childhood pneumonia. Methods We summarized cluster randomized controlled trials (cRCTs) and case-control studies of Hib conjugate vaccines and RCTs of 9- and 11-valent PC conjugate vaccines conducted in developing countries across outcome measures using standard meta-analysis methods. We used a set of standardized rules developed for the purpose of populating the LiST tool with required parameters to promote comparability across reviews of interventions against the major causes of childhood mortality. The estimates could be adjusted further to account for factors such as PC vaccine serotype content, PC serotype distribution and human immunodeficiency virus prevalence but this was not included as part of the LiST model approach. Results The available evidence from published data points to a summary effect of the Hib conjugate vaccine on clinical pneumonia of 4%, on clinical severe pneumonia of 6% and on radiologically confirmed pneumonia of 18%. Respective effectiveness estimates for PC vaccines (all valent) on clinical pneumonia is 7%, clinical severe pneumonia is 7% and radiologically confirmed pneumonia is 26%. Conclusions The findings indicated that radiologically confirmed pneumonia, as a severe morbidity proxy for mortality, provided better estimates for the LiST model of effect of interventions on mortality reduction than did other outcomes evaluated. The LiST model will use this to estimate the pneumonia mortality reduction which might be observed when scaling up Hib and PC conjugate vaccination in the context of an overall package of child health intervention

The Effect of Handwashing with Water or Soap on Bacterial Contamination of Hands

Handwashing is thought to be effective for the prevention of transmission of diarrhoea pathogens. However it is not conclusive that handwashing with soap is more effective at reducing contamination with bacteria associated with diarrhoea than using water only. In this study 20 volunteers contaminated their hands deliberately by touching door handles and railings in public spaces. They were then allocated at random to (1) handwashing with water, (2) handwashing with non-antibacterial soap and (3) no handwashing. Each volunteer underwent this procedure 24 times, yielding 480 samples overall. Bacteria of potential faecal origin (mostly Enterococcus and Enterobacter spp.) were found after no handwashing in 44% of samples. Handwashing with water alone reduced the presence of bacteria to 23% (p < 0.001). Handwashing with plain soap and water reduced the presence of bacteria to 8% (comparison of both handwashing arms: p < 0.001). The effect did not appear to depend on the bacteria species. Handwashing with non-antibacterial soap and water is more effective for the removal of bacteria of potential faecal origin from hands than handwashing with water alone and should therefore be more useful for the prevention of transmission of diarrhoeal diseases

Tendência das desigualdades sociodemográficas no pré-natal na Baixada Litorânea do estado do Rio de Janeiro, 2000-2020: um estudo ecológico

Objective: To analyze trends of sociodemographic inequalities in access and utilization of prenatal care in the ‘Baixada Litorânea’ of Rio de Janeiro, 2000-2020. Methods: Ecological study –Time series – of number of visits and adequacy of access to prenatal care. Absolute (differences) and relative (ratios) inequalities were estimated between extreme variable categories. Trends were estimated by Joinpoint regression. Results: 185,242 women were studied. The proportion of ≥7 visits increased, 2.9% (CI95% 0.7;5.1), annually, between 2013 (54.4%) and 2020 (64.7%), stable for women with &lt; 8 years of education. Adequacy of access increased 2.6% (CI95% 1.2;4.0), stable in ≥35 years-old women, and in those with ≥12 years of education. Absolute inequalities decreased (from 3.5 to 6.4%) for age and skin color, and relative inequalities (from 7.7 to 20.0%) for all variables. Conclusion: Access and number of visits increased, but persisted lower for adolescents, women with low-education, and who self-reported skin color/race brown/black women.Objetivo: Analizar la tendencia de las desigualdades sociodemográficas en el acceso y uso de la atención prenatal (APN) en la ‘Baixada Litorânea’ en Rio de Janeiro, 2000/2020. Métodos: Estudio ecológico – serie temporal – del número de consultas y adecuación del acceso a la APN. Se calcularon desigualdades absolutas (diferencias) e relativas (razones) entre categorías extremas de variables. Tendencias estimadas por regresión joinpoint. Resultados: Se estudiaron 185.242 gestantes. La proporción de ≥7 consultas aumentó en un 2,9% (IC95% 0,7;5,1), anualmente, entre 2013 (54,4%) e 2020 (64.7%), estable para menos de ocho años de escolaridad. La adecuación del acceso aumentó 2,6% (IC95% 1,2;4,0), estable en mujeres ≥35 años, e con ≥12 años de escolaridad. Disminuyeron las desigualdades absolutas (entre 3,5 y 6,4%) para edad y color/raza, y relativas (entre 7,7 y 20,0%) para todas las variables. Conclusion: Acceso e consultas aumentaron, pero persistieron menores entre adolescentes, baja escolaridad y color negro/marrón.Objetivo: Analisar a tendência das desigualdades sociodemográficas no acesso e utilização do pré-natal na Baixada Litorânea, estado do Rio de Janeiro, Brasil, em 2000- 2020. Métodos: Estudo ecológico – série temporal – do número de consultas e da adequação do acesso ao pré-natal. Desigualdades absolutas (diferenças) e relativas (razões) foram calculadas entre categorias extremas das variáveis; tendências foram estimadas por regressão joinpoint. Resultados: Foram estudadas 185.242 gestantes. A proporção de ≥7 consultas aumentou anualmente 2,4% (IC95% 1,1;3,7) entre 2013 (54,4%) e 2020 (63,4%), estável para escolaridade menor que oito anos. A adequação de acesso aumentou 2,6% (IC95% 1,2;4,0) entre 2014 e 2020, estável para mulheres ≥35 anos e escolaridade ≥12 anos. Diminuíram desigualdades absolutas (entre 3,5 e 6,4%) para idade e raça/cor da pele, e relativas (entre 7,7 e 20,0%) para todas as variáveis. Conclusão: Acesso e número de consultas aumentaram, mas permaneceram menores para adolescentes, mulheres de baixa escolaridade e raça/cor preta-parda

Assessment of Malawi's success in child mortality reduction through the lens of the Catalytic Initiative Integrated Health Systems Strengthening programme:Retrospective evaluation

Malawi is estimated to have achieved its Millennium Development Goal (MDG) 4 target. This paper explores factors influencing progress in child survival in Malawi including coverage of interventions and the role of key national policies. We performed a retrospective evaluation of the Catalytic Initiative (CI) programme of support (2007–2013). We developed estimates of child mortality using four population household surveys undertaken between 2000 and 2010. We recalculated coverage indicators for high impact child health interventions and documented child health programmes and policies. The Lives Saved Tool (LiST) was used to estimate child lives saved in 2013. The mortality rate in children under 5 years decreased rapidly in the 10 CI districts from 219 deaths per 1000 live births (95% confidence interval (CI) 189 to 249) in the period 1991–1995 to 119 deaths (95% CI 105 to 132) in the period 2006–2010. Coverage for all indicators except vitamin A supplementation increased in the 10 CI districts across the time period 2000 to 2013. The LiST analysis estimates that there were 10 800 child deaths averted in the 10 CI districts in 2013, primarily attributable to the introduction of the pneumococcal vaccine (24%) and increased household coverage of insecticide–treated bednets (19%). These improvements have taken place within a context of investment in child health policies and scale up of integrated community case management of childhood illnesses. Malawi provides a strong example for countries in sub–Saharan Africa of how high impact child health interventions implemented within a decentralised health system with an established community–based delivery platform, can lead to significant reductions in child mortality