The Mortality and Morbidity Transitions in Sub-Saharan Africa: Evidence from Adult Heights

In most developing countries, rising levels of nutrition and improvements in public health have led to declines in infant mortality and rising adult heights. In Sub-Saharan Africa we see a different pattern. Sub-Saharan Africa has seen large reductions in infant mortality over the last fifty years, but without any increase in protein and energy intake and against a background of stagnant, or declining, adult height. Adult height is a sensitive indicator of the nutrition and morbidity prevailing during the childhood of the cohort and can be taken as a measure of health human capital. Declining infant mortality rates in Sub-Saharan Africa appear to be driven by medical interventions that reduce infant mortality, rather than by broad based improvements in nutrition and public health measures, and may not be reflective of broad based health improvements.mortality, Sub-Saharan, morbidity, heights

The Height of Women in Sub-Saharan Africa: the Role of Health, Nutrition, and Income in Childhood

Most of the variation in height across countries in Sub-Saharan Africa is due to fixed effects, however, we find that variations in cohort height over time are sensitive to changes in infant mortality rate, GDP per capita, and protein intake, both at birth and in adolescence.Infant Mortality, Nutrition, Women’s Height, Stature, Sub-Saharan Africa

Delayed marriage, contraceptive use, and breastfeeding: Fertility patterns over time and wealth quintiles in sub-Saharan Africa

The rate of fertility decline has been slow in sub-Saharan Africa (SSA). Using the Demographic and Health Surveys for 21 SSA countries between 1990 and 2014, we examine the within-country fertility patterns by wealth, applying the Bongaarts (2015) proximate determinants model. We find that overall, fertility has declined in SSA for the richest, but not for the poorest, and this translates to a slow decline in the national-level total fertility rate. We find that breastfeeding periods are generally declining, putting upward pressure on the fertility rate. Contraceptive use is increasing, particularly for the richest, reducing fertility for these quintiles alone

Effect of Investment in Malaria Control on Child Mortality in Sub-Saharan Africa in 2002–2008

BACKGROUND: Around 8.8 million children under-five die each year, mostly due to infectious diseases, including malaria that accounts for 16% of deaths in Africa, but the impact of international financing of malaria control on under-five mortality in sub-Saharan Africa has not been examined. METHODS AND FINDINGS: We combined multiple data sources and used panel data regression analysis to study the relationship among investment, service delivery/intervention coverage, and impact on child health by observing changes in 34 sub-Saharan African countries over 2002-2008. We used Lives Saved Tool to estimate the number of lives saved from coverage increase of insecticide-treated nets (ITNs)/indoor residual spraying (IRS). As an indicator of outcome, we also used under-five mortality rate. Global Fund investments comprised more than 70% of the Official Development Assistance (ODA) for malaria control in 34 countries. Each $1 million ODA for malaria enabled distribution of 50,478 ITNs [95$3.90 vs. $7.05). Increased ITN/IRS coverage in high-burden countries led to 3,575 lives saved per 1 million children, as compared with 914 lives in lower-burden countries. Impact of ITN/IRS coverage on under-five mortality was significant among major child health interventions such as immunisation showing that 10% increase in households with ITN/IRS would reduce 1.5 [95%CI: 0.3-2.8] child deaths per 1000 live births. CONCLUSIONS: Along with other key child survival interventions, increased ITNs/IRS coverage has significantly contributed to child mortality reduction since 2002. ITN/IRS scale-up can be more efficiently prioritized to countries where malaria is a major cause of child deaths to save greater number of lives with available resources

Mortality and Morbidity Transitions in Sub-Saharan Africa: Evidence from Adult Height

In most developing countries, rising levels of nutrition and improvements in public health have led to declines in infant mortality and rising adult height. In Sub-Saharan Africa, however, we see a different pattern. Sub-Saharan Africa has seen large reductions in infant mortality over the last fifty years, but without any increase in protein or energy intake, and against a background of stagnant, or even declining, adult height. Adult height is a sensitive indicator of the nutrition and morbidity prevailing during the childhood of the cohort and can be taken as a measure of population health. Declining infant mortality rates in Sub-Saharan Africa appear to be driven by medical interventions that reduce infant mortality, and may not be reflective of broad-based health improvements

Health trends in Sub-Saharan Africa: Conflicting evidence from infant mortality rates and adult heights

We investigate trends in cohort infant mortality rates and adult heights in 39 developing countries since 1961. In most regions of the world improved nutrition, and reduced childhood exposure to disease, have lead to improvements in both infant mortality and adult stature. In Sub-Saharan Africa, however, despite declining infant mortality rates, adult heights have not increased. We argue that in Sub-Saharan Africa the decline in infant mortality may have been due to interventions that prevent infant deaths rather than improved nutrition and childhood morbidity. Despite declining infant mortality, Sub-Saharan Africa may not be experiencing increases in health human capital.Adult height Physical stature Human capital Sub-Saharan Africa Disease burden Infant mortality rate

Female work status and child nutritional outcome in Nigeria

This paper delves into the relationship between child nutritional outcome and (multiple) female work status in Nigeria from a micro perspective. The child nutritional outcome is proxied by child weight-for-age. Female work includes wage employment outside the household, household on-farm agricultural work, and household non-farm enterprise activities. Multilevel mixed-effects regression results show that female involvement in any type of work is positively and significantly associated with child weight-for-age. However, female simultaneous involvement in on-farm and non-farm work is the only female work combination positively and significantly associated with child weight-for-age. We describe the mechanism behind our findings through the lens of (positive) income effect versus (negative) childcare effect, which is consistent with two sets of further findings. On one hand, sub-sample analysis shows that female wage work significantly matters, in a non-linear fashion, for children aged two to five years (toddlers) and boys exclusively. On the other hand, female on-farm work significantly matters for children aged zero to two years (infants) and girls exclusively

Quality of care: measuring a neglected driver of improved health

Abstract The quality of care provided by health systems contributes towards efforts to reach sustainable development goal 3 on health and well-being. There is growing evidence that the impact of health interventions is undermined by poor quality of care in lower-income countries. Quality of care will also be crucial to the success of universal health coverage initiatives; citizens unhappy with the quality and scope of covered services are unlikely to support public financing of health care. Moreover, an ethical impetus exists to ensure that all people, including the poorest, obtain a minimum quality standard of care that is effective for improving health. However, the measurement of quality today in low- and middle-income countries is inadequate to the task. Health information systems provide incomplete and often unreliable data, and facility surveys collect too many indicators of uncertain utility, focus on a limited number of services and are quickly out of date. Existing measures poorly capture the process of care and the patient experience. Patient outcomes that are sensitive to health-care practices, a mainstay of quality assessment in high-income countries, are rarely collected. We propose six policy recommendations to improve quality-of-care measurement and amplify its policy impact: (i) redouble efforts to improve and institutionalize civil registration and vital statistics systems; (ii) reform facility surveys and strengthen routine information systems; (iii) innovate new quality measures for low-resource contexts; (iv) get the patient perspective on quality; (v) invest in national quality data; and (vi) translate quality evidence for policy impact