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Professional care delivery or traditional birth attendants? The impact of the type of care utilized by mothers on under-five mortality of their children.
Tropical Medicine and Health. 2018; 46(1)Background: Because of the high under-five mortality rate, the government in Zambia has adopted the World Health Organization (WHO) policy on child delivery which insists on professional maternal care. However, there are scholars who criticize this policy by arguing that although built on good intentions, the policy to ban traditional birth attendants (TBAs) is out of touch with local reality in Zambia. There is lack of evidence to legitimize either of the two positions, nor how the outcome differs between women with HIV and those without HIV. Thus, the aim of this paper is to investigate the effect of using professional maternal care or TBA care by mothers (during antenatal, delivery, and postnatal) on under-five mortality of their children. We also compare these outcomes between HIV-positive and HIV-negative women. Methods: By relying on data from the 2013-2014 Zambia Demographic Health Survey (ZDHS), we carried out propensity score matching (PSM) to investigate the effect of utilization of professional care or TBA during antenatal, childbirth, and postnatal on under-five mortality. This method allows us to estimate the average treatment effect on the treated (ATT). Results: Our results show that the use of professional care as opposed to TBAs in all three stages of maternal care increases the probability of children surviving beyond 5 years old. Specifically for women with HIV, professional care usage during antenatal, at birth, and during postnatal periods increases probability of survival by 0.07 percentage points (p.p), 0.71 p.p, and 0.87 p.p respectively. Similarly, for HIV-negative women, professional care usage during antenatal, at birth, and during postnatal periods increases probability of survival by 0.71 p.p, 0.52 p.p, and 0.37 p.p respectively. However, although there is a positive impact when mothers choose professional care over TBAs, the differences at all three points of maternal care are small. Conclusion: Given our findings, showing small differences in under-five child's mortality between utilizers of professional care and utilizers of TBAs, it may be questioned whether the government's intention of completely excluding TBAs (who despite being outlawed are still being used) without replacement by good quality professional care is the right decision. © 2018 The Author(s).
Effect of exclusive breastfeeding on selected adverse health and nutritional outcomes: a nationally representative study.
BMC Public Health. 2017 Nov 21; 17(1):889.BACKGROUND: Despite growing evidence in support of exclusive breastfeeding (EBF) among infants in the first 6 months of birth, the debate over the optimal duration of EBF continues. This study examines the effect of termination of EBF during the first 2, 4 and 6 months of birth on a set of adverse health and nutritional outcomes of infants. METHODS: Three waves of Bangladesh Demographic and Health Survey data were analysed using multivariate regression. The adverse health outcomes were: an episode of diarrhea, fever or acute respiratory infection (ARI) during the 2 weeks prior to the survey. Nutritional outcomes were assessed by stunting (height-for-age), wasting (weight-for-height) and underweight (weight-for-age). Population attributable fraction was calculated to estimate percentages of these six outcomes that could have been prevented by supplying EBF. RESULTS: Fifty-six percent of infants were exclusively breastfed during the first 6 months. Lack of EBF increased the odds of diarrhea, fever and ARI. Among the babies aged 6 months or less 27.37% of diarrhea, 13.24% of fever and 8.94% of ARI could have been prevented if EBF was not discontinued. If EBF was terminated during 0-2 months, 2-4 months the odds of becoming underweight were 2.16 and 2.01 times higher, respectively, than babies for whom EBF was not terminated. CONCLUSION: Children who are not offered EBF up to 6 months of their birth may suffer from a range of infectious diseases and under-nutrition. Health promotion and other public health interventions should be enhanced to encourage EBF at least up to six-month of birth. TRAIL REGISTRATION: Data of this study were collected following the guidelines of ICF International and Bangladesh Medical Research Council. The registration number of data collection is 132,989.0.000 and the data-request was registered on September 11, 2016.
Measuring postnatal care contacts for mothers and newborns: An analysis of data from the MICS and DHS surveys.
Journal of Global Health. 2017 Dec; 7(2):020502.Background: The postnatal period represents a vulnerable phase for mothers and newborns where both face increased risk of morbidity and death. WHO recommends postnatal care (PNC) for mothers and newborns to include a first contact within 24 hours following the birth of the child. However, measuring coverage of PNC in household surveys has been variable over time. The two largest household survey programs in low and middle-income countries, the UNICEF-supported Multiple Indicator Cluster Surveys (MICS) and USAID-funded Demographic and Health Surveys (DHS), now include modules that capture these measures. However, the measurement approach is slightly different between the two programs. We attempt to assess the possible measurement differences that might affect comparability of coverage measures. Methods: We first review the standard questionnaires of the two survey programs to compare approaches to collecting data on postnatal contacts for mothers and newborns. We then illustrate how the approaches used can affect PNC coverage estimates by analysing data from four countries; Bangladesh, Ghana, Kygyz Republic, and Nepal, with both MICS and DHS between 2010-2015. Results: We found that tools implemented todate by MICS and DHS (up to MICS round 5 and up to DHS phase 6) have collected PNC information in different ways. While MICS dedicated a full module to PNC and distinguishes immediate vs later PNC, DHS implemented a more blended module of pregnancy and postnatal and did not systematically distinguish those phases. The two survey programs differred in the way questions on postnatal care for mothers and newbors were framed. Subsequently, MICS and DHS surveys followed different methodological approach to compute the global indicator of postnatal contacts for mothers and newborns within two days following delivery. Regardless of the place of delivery, MICS estimates for postnatal contacts for mothers and newbors appeared consistently higher than those reported in DHS. The difference was however, far more pronounced in case of newborns. Conclusions: Difference in questionnaires and the methodology adopted to measure PNC have created comparability issues in the coverage levels. Harmonization of survey instruments on postnatal contacts will allow comparable and better assessment of coverage levels and trends.
Does postnatal care have a role in improving newborn feeding? A study in 15 sub-Saharan African countries.
Journal of Global Health. 2017 Dec; 7(2):020506.Background: Breastfeeding is known as a key intervention to improve newborn health and survival while prelacteal feeds (liquids other than breastmilk within 3 days of birth) represents a departure from optimal feeding practices. Recent programmatic guidelines from the WHO and UNICEF outline the need to improve newborn feeding and points to postnatal care (PNC) as a potential mechanism to do so. This study examines if PNC and type of PNC provider are associated with key newborn feeding practices: breastfeeding within 1 day and prelacteal feeds. Methods: We use data from the Demographic and Health Surveys for 15 sub-Saharan African countries to estimate 4 separate pooled, multilevel, logistic regression models to predict the newborn feeding outcomes. Findings: PNC is significantly associated with increased breastfeeding within 1day (OR = 1.35, P < 0.001) but is not associated with PLFs (OR = 1.04, P = 0.195). PNC provided by nurses, midwives and untrained health workers is also associated with higher odds of breastfeeding within 1 day of birth (OR = 1.39, P < 0.001, (OR = 1.95, P < 0.001) while PNC provided by untrained health workers is associated with increased odds of PLFs (OR = 1.20, P = 0.017). Conclusions: PNC delivered through customary care may be an effective strategy to improve the breastfeeding within 1 day but not to discourage PLFs. Further analysis should be done to examine how these variables operate at the country level to produce finer programmatic insight.
Child malnutrition in sub-Saharan Africa: A meta-analysis of demographic and health surveys (2006-2016).
PloS One. 2017; 12(5):e0177338.BACKGROUND: Sub-Saharan Africa has one of the highest levels of child malnutrition globally. Therefore, a critical look at the distribution of malnutrition within its sub-regions is required to identify the worst affected areas. This study provides a meta-analysis of the prevalence of malnutrition indicators (stunting, wasting and underweight) within four sub-regions of sub-Saharan Africa. METHODS: Cross-sectional data from the most recent Demographic and Health Surveys (2006-2016) of 32 countries in sub-Saharan Africa were used. The countries were grouped into four sub-regions (East Africa, West Africa, Southern Africa and Central Africa), and a meta-analysis was conducted to estimate the prevalence of each malnutrition indicator within each of the sub-regions. Significant heterogeneity was detected among the various surveys (I2 >50%), hence a random effect model was used, and sensitivity analysis was performed, to examine the effects of outliers. Stunting was defined as HAZ<-2; wasting as WHZ<-2 and underweight as WAZ<-2. RESULTS: Stunting was highest in Burundi (57.7%) and Malawi (47.1%) in East Africa; Niger (43.9%), Mali (38.3%), Sierra Leone (37.9%) and Nigeria (36.8%) in West Africa; Democratic Republic of Congo (42.7%) and Chad (39.9%) in Central Africa. Wasting was highest in Niger (18.0%), Burkina Faso (15.50%) and Mali (12.7%) in West Africa; Comoros (11.1%) and Ethiopia (8.70%) in East Africa; Namibia (6.2%) in Southern Africa; Chad (13.0%) and Sao Tome & Principle (10.5%) in Central Africa. Underweight was highest in Burundi (28.8%) and Ethiopia (25.2%) in East Africa; Niger (36.4%), Nigeria (28.7%), Burkina Faso (25.7%), Mali (25.0%) in West Africa; and Chad (28.8%) in Central Africa. CONCLUSION: The prevalence of malnutrition was highest within countries in East Africa and West Africa compared to the WHO Millennium development goals target for 2015. Appropriate nutrition interventions need to be prioritised in East Africa and West Africa if sub-Saharan Africa is to meet the WHO global nutrition target of improving maternal, infant and young child nutrition by 2025.
Signs of eclampsia during singleton deliveries and early neonatal mortality in low- and middle-income countries from three WHO regions.
International Journal of Gynaecology and Obstetrics. 2017 Oct; 139(1):50-54.OBJECTIVE: To determine the prevalence of eclampsia symptoms and to explore associations between eclampsia and early neonatal mortality. METHODS: The present secondary analysis included Demographic and Health Surveys data from 2005 to 2012; details of signs related to severe obstetric adverse events of singleton deliveries during interviewees' most recent delivery in the preceding 5 years were included. Data and delivery history were merged for pooled analyses. Convulsions-used as an indicator for having experienced eclampsia-and early neonatal mortality rates were compared, and a generalized random effect model, adjusted for heterogeneity between and within countries, was used to investigate the impact of presumed eclampsia on early neonatal mortality. RESULTS: The merged dataset included data from six surveys and 55 384 live deliveries that occurred in Colombia, Bangladesh, Indonesia, Mali, Niger, and Peru. Indications of eclampsia were recorded for 1.2% (95% confidence interval [CI] 1.0-1.3), 1.7% (95% CI 1.5-2.1), and 1.7% (95% CI 1.5-2.1) of deliveries reported from the American, South East Asian, and African regions, respectively. Pooled analyses demonstrated that eclampsia was associated with increased risk of early neonatal mortality (adjusted risk ratio 2.1 95% CI 1.4-3.2). CONCLUSION: Increased risk of early neonatal mortality indicates a need for strategies targeting the early detection of eclampsia and early interventions. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
Union of the Comoros. Adolescent contraceptive use. Data from l'Enquete Demographique et de Sante et a Indicateurs Multiples aux Comores (EDSC-MICS), 2012.
[Geneva, Switzerland], WHO, 2016 Nov. 4 p. (WHO/RHR/16.20)These facts sheets present information from 58 countries on adolescents’ (ages 15-19) contraceptive use by marital status. In addition, key information, such as reasons for non-use of contraception, as well as where adolescents obtain their contraceptive method, is included. The Demographic Health Surveys (DHS) program www.dhsprogrogram.com conducts nationally representative surveys in low- and middle-income countries. We use the most recently collected data from any country where 1) a survey has been conducted in the past 10 years (2006-2016) and 2) the data are publically available. Analyses of DHS in the fact sheets are weighted according to DHS guidance to be nationally representative. The data provided is aimed to help policymakers and programme planners reduce inequities in service provision and access by understanding adolescents’ current sources of contraception, utilised methods, and reasons why they are not using contraception.
Republic of Chad. Adolescent contraceptive use. Data from l'Enquete Demographique et de Sante et a Indicateurs Multiples au Tchad (EDST-MICS), 2014-15.
[Geneva, Switzerland], WHO, 2016 Nov. 4 p. (WHO/RHR/16.19)These facts sheets present information from 58 countries on adolescents’ (ages 15-19) contraceptive use by marital status. In addition, key information, such as reasons for non-use of contraception, as well as where adolescents obtain their contraceptive method, is included. The Demographic Health Surveys (DHS) program www.dhsprogrogram.com conducts nationally representative surveys in low- and middle-income countries. We use the most recently collected data from any country where 1) a survey has been conducted in the past 10 years (2006-2016) and 2) the data are publically available. Analyses of DHS in the fact sheets are weighted according to DHS guidance to be nationally representative. The data provided is aimed to help policymakers and programme planners reduce inequities in service provision and access by understanding adolescents’ current sources of contraception, utilised methods, and reasons why they are not using contraception.
Republic of Cameroon. Adolescent contraceptive use. Data from l'Enquete Demographique et de Sante et a Indicateurs Multiples du Cameroun (EDSC-MICS), 2011.
[Geneva, Switzerland], WHO, 2016 Nov. 4 p. (WHO/RHR/16.18)These facts sheets present information from 58 countries on adolescents’ (ages 15-19) contraceptive use by marital status. In addition, key information, such as reasons for non-use of contraception, as well as where adolescents obtain their contraceptive method, is included. The Demographic Health Surveys (DHS) program www.dhsprogrogram.com conducts nationally representative surveys in low- and middle-income countries. We use the most recently collected data from any country where 1) a survey has been conducted in the past 10 years (2006-2016) and 2) the data are publically available. Analyses of DHS in the fact sheets are weighted according to DHS guidance to be nationally representative. The data provided is aimed to help policymakers and programme planners reduce inequities in service provision and access by understanding adolescents’ current sources of contraception, utilised methods, and reasons why they are not using contraception.
Burkina Faso. Adolescent contraceptive use. Data from l'Enquete Demographique et de Sante et a Indicateurs Multiples du Burkina Faso (EDSBF-MICS), 2010.
[Geneva, Switzerland], WHO, 2016 Nov. 4 p. (WHO/RHR/16.16)
Republic of Benin. Adolescent contraceptive use. Data from l'Enquete Demographique et de Sante du Benin (EDSB), 2011-2012.
[Geneva, Switzerland], WHO, 2016 Nov. 4 p. (WHO/RHR/16.15)
World Health Organization infant and young child feeding indicators and their associations with child anthropometry: a synthesis of recent findings.
Maternal and Child Nutrition. 2014 Jan; 10(1):1-17.As the World Health Organization (WHO) infant and young child feeding (IYCF) indicators are increasingly adopted, a comparison of country-specific analyses of the indicators’ associations with child growth is needed to examine the consistency of these relationships across contexts and to assess the strengths and potential limitations of the indicators. This study aims to determine cross-country patterns of associations of each of these indicators with child stunting, wasting, height-for-age z-score (HAZ) and weight-for-height z-score (WHZ). Eight studies using recent Demographic and Health Surveys data from a total of nine countries in sub-Saharan Africa (nine), Asia (three) and the Caribbean (one) were identified. The WHO indicators showed mixed associations with child anthropometric indicators across countries. Breastfeeding indicators demonstrated negative associations with HAZ, while indicators of diet diversity and overall diet quality were positively associated with HAZ in Bangladesh, Ethiopia, India and Zambia (P < 0.05).These same complementary feeding indicators did not show consistent relationships with child stunting. Exclusive breastfeeding under 6 months of age was associated with greater WHZ in Bangladesh and Zambia (P < 0.05), although CF indicators did not show strong associations with WHZ or wasting. The lack of sensitivity and specificity of many of the IYCF indicators may contribute to the inconsistent associations observed.The WHO indicators are clearly valuable tools for broadly assessing the quality of child diets and for monitoring population trends in IYCF practices over time. However, additional measures of dietary quality and quantity may be necessary to understand how specific IYCF behaviours relate to child growth faltering.
Migration as a Risk Factor for HIV Infection among Youths in Sub-Saharan Africa: Evidence from the DHS.
Annals of the American Academy of Political and Social Science. 2013 Jul; 648(1):136-158.Of the estimated 10 million youths living with HIV worldwide, 63 percent live in sub-Saharan Africa. This article focuses on migration as a risk factor of HIV infection among the youths in sub-Saharan Africa. The study is based on multilevel modeling, applied to the youth sample of the Demographic and Health Surveys (DHS), conducted from 2003 to 2008 in nineteen countries. The analysis takes into account country-level and regional-level variations. The results suggest that across countries in sub-Saharan Africa, migrants have on average about 50 percent higher odds of HIV infection than nonmigrants. The higher risk among migrants is to a large extent explained by differences in demographic and socioeconomic factors. In particular, migrants are more likely to be older, to have been married, or to live in urban areas, all of which are associated with higher risks of HIV infection. The higher risk among youths who have been married is particularly pronounced among young female migrants.
Routine vaccination coverage in low- and middle-income countries: further arguments for accelerating support to child vaccination services.
Global Health Action. 2013; 6:20343.BACKGROUND AND OBJECTIVE: The Expanded Programme on Immunization was introduced by the World Health Organization (WHO) in all countries during the 1970s. Currently, this effective public health intervention is still not accessible to all. This study evaluates the change in routine vaccination coverage over time based on survey data and compares it to estimations by the WHO and United Nations Children's Fund (UNICEF). DESIGN: Data of vaccination coverage of children less than 5 years of age was extracted from Demographic and Health Surveys (DHS) conducted in 71 low- and middle-income countries during 1986-2009. Overall trends for vaccination coverage of tuberculosis, diphtheria, tetanus, pertussis, polio and measles were analysed and compared to WHO and UNICEF estimates. RESULTS: From 1986 to 2009, the annual average increase in vaccination coverage of the studied diseases ranged between 1.53 and 1.96% units according to DHS data. Vaccination coverage of diphtheria, tetanus, pertussis, polio and measles was all under 80% in 2009. Non-significant differences in coverage were found between DHS data and WHO and UNICEF estimates. CONCLUSIONS: The coverage of routine vaccinations in low- and middle-income countries may be lower than that previously reported. Hence, it is important to maintain and increase current vaccination levels.
Child mortality estimation: Methods used to adjust for bias due to AIDS in estimating trends in under-five mortality.
PLOS Medicine. 2012 Aug; 9(8):e1001298.In most low- and middle-income countries, child mortality is estimated from data provided by mothers concerning the survival of their children using methods that assume no correlation between the mortality risks of the mothers and those of their children. This assumption is not valid for populations with generalized HIV epidemics, however, and in this review, we show how the United Nations Inter-agency Group for Child Mortality Estimation (UN IGME) uses a cohort component projection model to correct for AIDS-related biases in the data used to estimate trends in under-five mortality. In this model, births in a given year are identified as occurring to HIV-positive or HIV-negative mothers, the lives of the infants and mothers are projected forward using survivorship probabilities to estimate survivors at the time of a given survey, and the extent to which excess mortality of children goes unreported because of the deaths of HIV-infected mothers prior to the survey is calculated. Estimates from the survey for past periods can then be adjusted for the estimated bias. The extent of the AIDS-related bias depends crucially on the dynamics of the HIV epidemic, on the length of time before the survey that the estimates are made for, and on the underlying non-AIDS child mortality. This simple methodology (which does not take into account the use of effective antiretroviral interventions) gives results qualitatively similar to those of other studies.
Prenatal care associated with reduction of neonatal mortality in Sub-Saharan Africa: evidence from Demographic and Health Surveys.
Acta Obstetricia et Gynecologica Scandinavica. 2011 Jul; 90(7):779-90.OBJECTIVE: To determine whether prenatal care by a skilled provider (physician, nurse or midwife) and specific prenatal interventions were associated with decreased neonatal mortality. DESIGN: Mothers' reports in nationally representative surveys (conducted 2003-2009) about their most recent delivery were analyzed. Setting. Sub-Saharan Africa, 17 least developed countries (UN designation). POPULATION: 89 655 women aged 15-49 years with a singleton birth within 3 years prior to survey. Methods. Logistic regression models were used to measure the associations between having a skilled prenatal provider, as well as specific interventions, and neonatal mortality. MAIN OUTCOME MEASURES: Neonatal mortality, defined as a live birth ending in death at less than one month of age. RESULTS: Overall, 70.7% of women saw a skilled prenatal provider during their previous pregnancy. Prenatal care from a skilled provider was associated with a decreased neonatal mortality risk compared with no provider [adjusted odds ratio (AOR) 0.70, 95% confidence interval (CI) 0.62-0.80] and compared with an unskilled provider (AOR 0.81, 95% CI 0.68-0.96). The most effective prenatal interventions were weight (AOR 0.71, 95% CI 0.64-0.80) and blood pressure measurements (AOR 0.77, 95% CI 0.69-0.86), and two or more tetanus immunizations (AOR 0.78, 95% CI 0.70-0.86). Four or more prenatal visits compared with none were associated with decreased neonatal mortality risk (AOR 0.68, 95% CI 0.59-0.79). CONCLUSIONS: Prenatal care provided by skilled providers, at least four prenatal visits, weight and blood pressure assessment, and two or more tetanus immunizations were associated with decreased neonatal mortality in Sub-Saharan African countries. (c) 2011 The Authors Acta Obstetricia et Gynecologica Scandinavica(c) 2011 Nordic Federation of Societies of Obstetrics and Gynecology.
The impacts of the HIV/AIDS pandemic and socioeconomic development on the living arrangements of older persons in sub-Saharan Africa: a country-level analysis.
American Journal of Community Psychology. 2009 Sep; 44(1-2):136-47.This study investigates whether socioeconomic development and the HIV/AIDS pandemic are associated with living arrangement patterns in older persons in 23 sub-Saharan African countries. Country-level aggregate data were taken from previous household surveys and information provided by the United Nations, the World Bank, and the World Health Organization. Results showed that 13.5% of older persons (aged 60 years or over) were living with grandchildren but not adult children (i.e., skipped generation households). Countries higher in HIV/AIDS prevalence had more skipped generation households, and also more older persons living with spouse only and fewer older persons living with other relatives. Countries with higher socioeconomic development had fewer older persons living with children younger than 25 years old and more living with spouse only or with other relatives and unrelated persons. The pandemic and socioeconomic development combine to accelerate the breakdown of the extended family structure so that older persons are less and less likely to reside with, and to receive support from, their children.
What difference do the new WHO child growth standards make for the prevalence and socioeconomic distribution of undernutrition?
Food and Nutrition Bulletin. 2009 Mar; 30(1):3-15.BACKGROUND: The World Health Organization has recently established revised child growth standards. OBJECTIVE: To assess how the use of these new standards affects the estimated prevalence and socioeconomic distribution of stunting and underweight among children in a large number of low- and middle-income countries. METHODS: We analyzed Demographic and Health Survey data for stunting and underweight in 41 low- and middle-income countries employing these new standards and compared the results with those produced by analyses of the same data using the old growth references. RESULTS: For all 41 countries, the prevalence of stunting increases with the adoption of the new standards, by 5.4 percentage points on average (95% CI: 5.1, 5.7). The prevalence of underweight decreases in all but two of the countries, by an average of 2.9 percentage points (95% CI: 2.7, 3.2). The impact of using the new standards on socioeconomic inequalities is mixed. For stunting, inequalities tend to rise in absolute terms but tend to decline in relative terms. The impact on underweight is inconsistent across countries. Poor children suffer most from undernutrition, but even among the better-off children in developing countries, undernutrition rates are high enough to deserve attention. CONCLUSIONS: These results suggest that the adoption of the new WHO standards in itself is unlikely to affect policies dramatically. They do confirm, however, that different strategies are likely to be required in these countries to effectively address undernutrition among children at different socioeconomic levels.
Journal of Health, Population, and Nutrition. 2008 Sep; 26(3):273-9.Bangladesh is currently one of the very few countries in the world, which is on target for achieving the Millennium Development Goal (MDG) 4 relating to child mortality. There have been very rapid reductions in mortality, especially in recent years and among children aged over one month. However, this rate of reduction may be difficult to sustain and may impede the achievement of MDG 4. Neonatal deaths now contribute substantially (57%) to overall mortality of children aged less than five years, and reductions in neonatal mortality are difficult to achieve and have been slow in Bangladesh. There are some interesting attributes of the mortality decline in Bangladesh. Mortality has declined faster among girls than among boys, but the poorest have not benefited from the reduction in mortality. There has also been a relative absence of a decline in mortality in urban areas. The age and cause of death pattern of under-five mortality indicate certain interventions that need to be scaled up rapidly and reach high coverage to achieve MDG 4 in Bangladesh. These include skilled attendance at delivery, postnatal care for the newborn, appropriate feeding of the young infant and child, and prevention and management of childhood infections. The latest (2007) Bangladesh Demographic and Health Survey shows that Bangladesh has made sustained and remarkable progress in many areas of child health. More than 80% of children are receiving all vaccines. The use of oral rehydration solution for diarrhoea is high, and the coverage of vitamin A among children aged 9-59 months has been consistently increasing. However, poor quality of care, misperceptions regarding the need for care, and other social barriers contribute to low levels of care-seeking for illnesses of the newborns and children. Improvements in the health system are essential for removing these barriers, as are effective strategies to reach families and communities with targeted messages and information. Finally, there are substantial health-system challenges relating to the design and implementation, at scale, of interventions to reduce neonatal mortality.
Weekly Epidemiological Record. 2008 Apr 4; 83(14):119-124.Zambia has a population of approximately 12 million. According to estimates from the 2001-2002 Zambia Demographic and Health Survey,1 between 1997 and 2001, the rate of neonatal mortality was 37/1000 births, the infant mortality rate was 95/1000 births and the maternal mortality ratio was 729/100 000 live births. In order to protect mothers and their newborn babies against tetanus, WHO recommends that tetanus toxoid (TT) vaccine be given to all pregnant women; Zambia follows WHO's recommendations. In 2006, 79% of all pregnant women received a protective dose of TT vaccine. A total of 60% of all deliveries took place in hygienic conditions (administrative data). WHO and UNICEF estimate that in 2006, 90% of births were protected against tetanus. (excerpt)
Lancet. 2007 Dec 15; 370(9604):1975.A UNICEF report published on Dec 10 gives the most comprehensive data to date on progress towards the Millennium Development Goals (MDGs). Although there has been much international attention focused on MDG-4-to reduce under-5 mortality by two-thirds between 1990 and 2015-the report also details child-focused statistical information on all of the eight MDGs, in addition to data on World Fit for Children targets. These targets cover important factors in child health and wellbeing which are not included in the MDGs, such as child labour, violence, and discrimination. The report combines all appropriate and latest available information and relies on data from UNICEF global databases, Multiple Indicator Cluster Surveys, and Demographic and Health Surveys, which vary in the time period in which information is collected and collated. Therefore, although some statistics in the report are new, other figures are more familiar. (excerpt)
Findings Infobriefs. 2007 May; (136): p.The specific objectives of this project - financed through an IDA credit of $28.7 million (2002-05) - were to : (i) provide resources that would enable the government to implement a balanced, diversified multi-sector response, engaging all relevant government sectors, non-governmental organizations (NGOs) and grassroots initiatives; (ii) to expand contributions made by the Ministry of Health ( MOH ) engage civil society in the fight against AIDS; and (iii) finance eligible activities conducted by civil society organizations, including NGOs, community-based organizations (CBOs), faith-based organizations (FBOs), trade and professional associations, associations of people living with HIV/AIDS (PLWHAs), districts, and line ministries to ensure a rapid multisector scaling-up of HIV prevention and care activities in all regions and at all administrative levels. (excerpt)
Standard deviation of anthropometric Z-scores as a data quality assessment tool using the 2006 WHO growth standards: A cross country analysis.
Bulletin of the World Health Organization. 2007 Jun; 85(6):441-448.Height- and weight-based anthropometric indicators are used worldwide to characterize the nutritional status of populations. Based on the 1978 WHO/National Center for Health Statistics (NCHS) growth reference, the World Health Organization has previously indicated that the standard deviation (SD) of Z-scores of these indicators is relatively constant across populations, irrespective of nutritional status. As such, the SD of Z-scores can be used as quality indicators for anthropometric data. In 2006, WHO published new growth standards. Here, we aim to assess whether the SD of height- and weight-based Z-score indicators from the 2006 WHO growth standards can still be used to assess data quality. We examined data on children aged 0-59 months from 51 Demographic and Health Surveys (DHS) in 34 developing countries. We used 2006 growth standards to assign height-for-age Z-scores (HAZ), weight-for-age Z-scores (WAZ), weight-for-height Z-scores (WHZ) and body-mass-index-for-age Z-scores (BMIZ). We also did a stratified analysis by age group. The SD for all four indicators were independent of their respective mean Z-scores across countries. Overall, the 5th and 95th percentiles of the SD were 1.35 and 1.95 for HAZ, 1.17 and 1.46 for WAZ, 1.08 and 1.50 for WHZ and 1.08 and 1.55 for BMIZ. Our results concur with the WHO assertion that SD is in a relatively small range for each indicator irrespective of where the Z-score mean lies, and support the use of SD as a quality indicator for anthropometric data. However, the ranges of SDs for all four indicators analysed were consistently wider than those published previously by WHO. (author's)
Lancet. 2007 May 26; 369(9575):1768-1769.In today's Lancet, Steven Radelet and Bilal Siddiqi examine the associations between evaluation scores assigned by the Global Fund to Fight AIDS, Tuberculosis and Malaria to recipient countries and characteristics of grants and countries. This analysis complements a previous look at the capacity of recipient countries to disburse Global Fund money. The selection of the outcome variable-grant scores and disbursement rates-differed, but both analyses included several common programmatic and country-specific variables. Both studies found that poor countries are not disadvantaged compared with middle-income recipients in terms of performance. The fundamental question for both studies, however, is what does the selected outcome variable measure. Grant performance scores from the Global Fund have several limitations. First, the recipients define the numerical targets for each quarter for the progress indicators. The scores do not allow for comparisons of progress across recipients compared with baseline. An A recipient has not necessarily increased coverage of key interventions more than a B1 recipient. Category A represents grants reaching or exceeding expectations, whereas B1 covers grants that have adequate performance. Second, validation of reported progress against programmatic benchmarks is inherently difficult in countries with weak health-information systems. Progress on delivery of interventions has not been assessed with population-based measurements of the delivery of the interventions funded by the grants, but rather on more upstream processes or provider-based data-collection mechanisms. Third, the evaluation process is not entirely independent and includes progress monitoring by local agents selected by the Fund. (excerpt)
New York, New York, UNICEF, 2005 Nov.  p.FGM/C is a fundamental violation of human rights. In the absence of any perceived medical necessity, it subjects girls and women to health risks and has life-threatening consequences. Among those rights violated are the right to the highest attainable standard of health and to bodily integrity. Furthermore, it could be argued that girls (under 18) cannot be said to give informed consent to such a potentially damaging practice as FGM/C. FGM/C is, further, an extreme example of discrimination based on sex. The Convention on the Elimination of All Forms of Discrimination against Women defines discrimination as "any distinction, exclusion or restriction made on the basis of sex which has the effect or purpose of impairing or nullifying the recognition, enjoyment or exercise by women, irrespective of their marital status, on a basis of equality of men and women, of human rights and fundamental freedoms in the political, economic, social, cultural, civil or any other field." Used as a way to control women's sexuality, FGM/C is a main manifestation of gender inequality and discrimination "related to the historical suppression and subjugation of women," denying girls and women the full enjoyment of their rights and liberties. (excerpt)