Space-time smoothing of mortality estimates in children aged 5-14 in Sub-Saharan Africa

To meet the SDG requirement of spatial disaggregation of indicators, several methods have been developed to generate estimates of under-five mortality at the sub-national level. The reliability of sub-national mortality estimates in children aged 5-14 with the available survey data has not been evaluated so far. We generate Admin-1 sub-national estimates of the risk of dying in children aged less than five (5q0) and those aged 5 to 14 years old (10q5). We use 96 Demographic and Health Surveys (DHS) in 20 Sub-Saharan countries having at least 3 surveys designed to be representative at a sub-national level. The estimates account for the complex sample design of DHS and HIV-related biases in young children. A Bayesian space-time model previously developed for under-five mortality is used to smooth estimates across space and time in both age groups to reduce problems associated with data sparsity. The posterior distributions of the probability 10q5 are used to compute coefficients of variation and assess precision. Sufficiently precise estimates are retained to study the sub-national relationship between age-specific mortality rates (5q0 and 10q5), accounting for uncertainty in sub-national levels. Out of 1,132 space-time estimates, 62.3% are considered sufficiently precise with high heterogeneity across countries. Across all periods, sub-national estimates of mortality in children aged 0-4 are highly correlated with those in older children and young adolescents but this correlation is largely driven by the mortality decline. Within specific periods of time, it is often impossible to assess the relationship between mortality rates in the two age groups at the sub-national level, except in Nigeria, Ethiopia, Cameroon, Senegal and Zambia. As increased attention is devoted to survival after age 5, more research is needed to ensure that sub-national areas with specific interventions required for older children can be correctly identified.

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RTS,S/AS01, a vaccine targeting pre-erythrocytic stages of Plasmodium falciparum

Emerging Topics in Life Sciences ◽

10.1042/etls20170101 ◽

2017 ◽

Vol 1 (6) ◽

pp. 533-537

Author(s):

Lorenz von Seidlein ◽

Borimas Hanboonkunupakarn ◽

Podjanee Jittmala ◽

Sasithon Pukrittayakamee

Keyword(s):

Protective Efficacy ◽

Age Groups ◽

Sub Saharan Africa ◽

Phase Iii ◽

European Medicines Agency ◽

Older Children ◽

Pivotal Phase ◽

Malaria Epidemiology ◽

Maximum Benefit ◽

Sub Saharan

RTS,S/AS01 is the most advanced vaccine to prevent malaria. It is safe and moderately effective. A large pivotal phase III trial in over 15 000 young children in sub-Saharan Africa completed in 2014 showed that the vaccine could protect around one-third of children (aged 5–17 months) and one-fourth of infants (aged 6–12 weeks) from uncomplicated falciparum malaria. The European Medicines Agency approved licensing and programmatic roll-out of the RTSS vaccine in malaria endemic countries in sub-Saharan Africa. WHO is planning further studies in a large Malaria Vaccine Implementation Programme, in more than 400 000 young African children. With the changing malaria epidemiology in Africa resulting in older children at risk, alternative modes of employment are under evaluation, for example the use of RTS,S/AS01 in older children as part of seasonal malaria prophylaxis. Another strategy is combining mass drug administrations with mass vaccine campaigns for all age groups in regional malaria elimination campaigns. A phase II trial is ongoing to evaluate the safety and immunogenicity of the RTSS in combination with antimalarial drugs in Thailand. Such novel approaches aim to extract the maximum benefit from the well-documented, short-lasting protective efficacy of RTS,S/AS01.

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Diarrhoea morbidity and mortality in older children, adolescents, and adults

Epidemiology and Infection ◽

10.1017/s0950268810000592 ◽

2010 ◽

Vol 138 (9) ◽

pp. 1215-1226 ◽

Cited By ~ 51

Author(s):

C. L. FISCHER WALKER ◽

R. E. BLACK

Keyword(s):

Eastern Mediterranean ◽

Age Groups ◽

Eastern Mediterranean Region ◽

Mortality Rates ◽

Incidence Rates ◽

Morbidity And Mortality ◽

Mortality Data ◽

Older Children ◽

Incidence And Mortality ◽

Adolescents And Adults

SUMMARYDiarrhoea is a leading cause of morbidity and mortality yet diarrhoea specific incidence and mortality rates for older children, adolescents, and adults have not been systematically calculated for many countries. We conducted a systematic literature review to generate regional incidence rates by age and to summarize diarrhoea specific mortality rates for regions of the world with inadequate vital registration data. Diarrhoea morbidity rates range from 29·9 episodes/100 person-years for adults in the South East Asian region to 88·4 episodes/100 person-years in older children in the Eastern Mediterranean region and have remained unchanged in the last 30 years. Diarrhoea mortality rates decline as the child ages and remain relatively constant during adulthood. These data are critical for improving estimates worldwide and further highlight the need for improved diarrhoea specific morbidity and mortality data in these age groups.

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Diarrhea and associated factors among under five children in sub-Saharan Africa: Evidence from demographic and health surveys of 34 sub-Saharan countries

PLoS ONE ◽

10.1371/journal.pone.0257522 ◽

2021 ◽

Vol 16 (9) ◽

pp. e0257522

Author(s):

Getu Debalkie Demissie ◽

Yigizie Yeshaw ◽

Wallelign Aleminew ◽

Yonas Akalu

Keyword(s):

Associated Factors ◽

Maternal Education ◽

Wealth Index ◽

Water Source ◽

Sub Saharan Africa ◽

Demographic And Health Surveys ◽

African Countries ◽

Under Five ◽

Under Five Children ◽

Sub Saharan

Introduction Diarrhea is responsible for the death of more than 90% of under-five children in low and lower-middle income countries. Regionally, South Asia and sub-Saharan Africa accounted for 88% of deaths with the same age group. Therefore, the aim of this study was to determine the prevalence and associated factors of diarrhea among children under-five years in sub-Saharan Africa. Methods The appended, most recent demographic and health survey datasets of 34 sub-Saharan African countries were used to determine the prevalence and associated factors of diarrhea among under-five children in the region. A total weighted sample of 330,866 under-five children were included in the study. Both bivariable and multivariable multilevel logistic regression were done to determine the associated factors of diarrhea among under five children in sub-Saharan Africa. The Odds Ratio (OR) with a 95% Confidence Interval (CI) was calculated for those potential factors included in the final model. Result The overall prevalence of diarrhea in this study was 15.3% (95% CI: 15.1–15.4). Those children of mothers aged 15–24 (AOR = 1.26; 95% CI: 1.23, 1.30) and 25–34 years (AOR = 1.15; 95%CI: 1.12, 1.18), those children of mothers with no education (AOR = 1.69; 95%CI: 1.57–1.82), primary education (AOR = 1.73; 95%CI: 1.61–1.86) and secondary education (AOR = 1.49; 95%CI: 1.38–1.59) had higher odds of having diarrhea. Those children from poorest (AOR = 1.14; 95%CI: 1.10, 1.19), poorer (AOR = 1.12; 95%CI: 1.08–1.17), middle (AOR = 1.06; 95%CI: 1.02, 1.10), and richer (AOR = 1.14; 95%CI: 1.04–1.12) households had higher chance of having diarrhea compared to their counterparts. Conclusion This study found that the prevalence of childhood diarrhea morbidity in sub-Saharan Africa was high. Maternal age, wealth index, maternal education, maternal occupation, age of child, time of initiation of breast feeding and time to get water source were significantly associated with diarrhea. Therefore, intervention through health education and health promotion for mothers/caretakers who are poor, less educated, and young should be designed to prevent diarrhea in the region.

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Clusters of sub-Saharan African countries based on sociobehavioural characteristics and associated HIV incidence

10.1101/620450 ◽

2019 ◽

Cited By ~ 2

Author(s):

Aziza Merzouki ◽

Janne Estill ◽

Erol Orel ◽

Kali Tal ◽

Olivia Keiser

Keyword(s):

National Level ◽

Principal Component ◽

Sub Saharan Africa ◽

Demographic And Health Surveys ◽

People Living With Hiv ◽

Hiv Incidence ◽

African Countries ◽

Aggregated Data ◽

Sub Saharan ◽

Ssa Countries

AbstractIntroductionHIV incidence varies widely between sub-Saharan African (SSA) countries. This variation coincides with a substantial sociobehavioural heterogeneity, which complicates the design of effective interventions. In this study, we investigated how sociobehavioural heterogeneity in sub-Saharan Africa could account for the variance of HIV incidence between countries.MethodsWe analysed aggregated data, at the national-level, from the most recent Demographic and Health Surveys of 29 SSA countries [2010-2017], which included 594’644 persons (183’310 men and 411’334 women). We preselected 48 demographic, socio-economic, behavioural and HIV-related attributes to describe each country. We used Principal Component Analysis to visualize sociobehavioural similarity between countries, and to identify the variables that accounted for most sociobehavioural variance in SSA. We used hierarchical clustering to identify groups of countries with similar sociobehavioural profiles, and we compared the distribution of HIV incidence (estimates from UNAIDS) and sociobehavioural variables within each cluster.ResultsThe most important characteristics, which explained 69% of sociobehavioural variance across SSA among the variables we assessed were: religion; male circumcision; number of sexual partners; literacy; uptake of HIV testing; women’s empowerment; accepting attitude toward people living with HIV/AIDS; rurality; ART coverage; and, knowledge about AIDS. Our model revealed three groups of countries, each with characteristic sociobehavioural profiles. HIV incidence was mostly similar within each cluster and different between clusters (median(IQR); 0.5/1000(0.6/1000), 1.8/1000(1.3/1000) and 5.0/1000(4.2/1000)).

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Geographical variations of the associations between health interventions and all-cause under-five mortality in Uganda

BMC Public Health ◽

10.1186/s12889-019-7636-x ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Betty B. Nambuusi ◽

Julius Ssempiira ◽

Fredrick E. Makumbi ◽

Jürg Utzinger ◽

Simon Kasasa ◽

...

Keyword(s):

National Level ◽

Intermittent Preventive Treatment ◽

Bayesian Variable Selection ◽

Health Interventions ◽

Climatic Data ◽

Under Five ◽

Spatial Targeting ◽

Geographical Variations ◽

Control Programmes ◽

National Estimates

Abstract Background To reduce the under-five mortality (U5M), fine-gained spatial assessment of the effects of health interventions is critical because national averages can obscure important sub-national disparities. In turn, sub-national estimates can guide control programmes for spatial targeting. The purpose of our study is to quantify associations of interventions with U5M rate at national and sub-national scales in Uganda and to identify interventions associated with the largest reductions in U5M rate at the sub-national scale. Methods Spatially explicit data on U5M, interventions and sociodemographic indicators were obtained from the 2011 Uganda Demographic and Health Survey (DHS). Climatic data were extracted from remote sensing sources. Bayesian geostatistical Weibull proportional hazards models with spatially varying effects at sub-national scales were utilized to quantify associations between all-cause U5M and interventions at national and regional levels. Bayesian variable selection was employed to select the most important determinants of U5M. Results At the national level, interventions associated with the highest reduction in U5M were artemisinin-based combination therapy (hazard rate ratio (HRR) = 0.60; 95% Bayesian credible interval (BCI): 0.11, 0.79), initiation of breastfeeding within 1 h of birth (HR = 0.70; 95% BCI: 0.51, 0.86), intermittent preventive treatment (IPTp) (HRR = 0.74; 95% BCI: 0.67, 0.97) and access to insecticide-treated nets (ITN) (HRR = 0.75; 95% BCI: 0.63, 0.84). In Central 2, Mid-Western and South-West, largest reduction in U5M was associated with access to ITNs. In Mid-North and West-Nile, improved source of drinking water explained most of the U5M reduction. In North-East, improved sanitation facilities were associated with the highest decline in U5M. In Kampala and Mid-Eastern, IPTp had the largest associated with U5M. In Central1 and East-Central, oral rehydration solution and postnatal care were associated with highest decreases in U5M respectively. Conclusion Sub-national estimates of the associations between U5M and interventions can guide control programmes for spatial targeting and accelerate progress towards mortality-related Sustainable Development Goals.

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Mortality Decline in Kenya: A Reexamination of Recent Under-Five Mortality Estimate

International Journal of Population Research ◽

10.1155/2015/296437 ◽

2015 ◽

Vol 2015 ◽

pp. 1-8 ◽

Cited By ~ 2

Author(s):

George Odwe ◽

Anne Khasakhala ◽

Titus Agwanda ◽

Andrew Imbwaga ◽

Zena Lyaga

Keyword(s):

Mortality Rate ◽

Health Surveys ◽

Mortality Decline ◽

Demographic And Health Surveys ◽

Under Five ◽

Survival Status ◽

Effective Interventions ◽

Mortality Estimate ◽

Using Data ◽

Mortality Estimates

This study examined the extent of birth displacement and its effect on the under-five mortality estimates in Kenya. Using data from 2003 and 2008/09 Kenya Demographic and Health Surveys, we evaluate the variability of birth displacement by region and place of residence based on the survival status of the child. We compute birth ratios for children born in the 5th calendar year preceding each survey and note the possible effect on under-five mortality estimates. Results show that under-five mortality estimates in 2008/09 survey are smaller than that of a similar period in 2003 survey by 17 percent. Overall, birth ratios for the 5th calendar year were below 100 percent suggesting presence of birth displacement. However, there was no variance in the displacement between surviving and dead children, hence modest impact on the under-five mortality rate. Evidence suggests that the remarkable decline in the under-five mortality rate recorded in 2008/09 is a function of both overestimation of mortality rate in 2003 survey and underestimation in 2008/09 survey. We recommend that data from more than one source be used to interpret under-five mortality decline and further research should be conducted linking the observed mortality decline to the delivery of known effective interventions.

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Age patterns in overweight and wasting prevalence of under 5-year-old children from low- and middle-income countries

International Journal of Obesity ◽

10.1038/s41366-021-00911-5 ◽

2021 ◽

Author(s):

Luiza I. C. Ricardo ◽

Giovanna Gatica-Domínguez ◽

Inácio Crochemore-Silva ◽

Paulo A. R. Neves ◽

Juliana dos Santos Vaz ◽

...

Keyword(s):

Low Income ◽

Age Groups ◽

Demographic And Health Surveys ◽

Older Children ◽

Middle Income ◽

Middle Income Countries ◽

Multiple Indicator ◽

Standard Deviations ◽

Nationally Representative ◽

Low And Middle Income

Abstract Objectives To describe how overweight and wasting prevalence varies with age among children under 5 years in low- and middle-income countries (LMICs). Methods We used data from nationally representative Demographic and Health Surveys and Multiple Indicator Cluster Surveys. Overweight and wasting prevalence were defined as the proportions of children presenting mean weight for length/height (WHZ) more than 2 standard deviations above or below 2 standard deviations from the median value of the 2006 WHO standards, respectively. Descriptive analyses include national estimates of child overweight and wasting prevalence, mean, and standard deviations of WHZ stratified by age in years. National results were pooled using the population of children aged under 5 years in each country as weight. Fractional polynomials were used to compare mean WHZ with both overweight and wasting prevalence. Results Ninety national surveys from LMICs carried out between 2010 and 2019 were included. The overall prevalence of overweight declined with age from 6.3% for infants (aged 0–11 months) to 3.0% in 4 years olds (p = 0.03). In all age groups, lower prevalence was observed in low-income compared to upper-middle-income countries. Wasting was also more frequent among infants, with a slight decrease between the first and second year of life, and little variation thereafter. Lower-middle-income countries showed the highest wasting prevalence in all age groups. On the other hand, mean WHZ was stable over the first 5 years of life, but the median standard deviation for WHZ decreased from 1.39 in infants to 1.09 in 4-year-old children (p < 0.001). For any given value of WHZ, both overweight and wasting prevalence were higher in infants than in older children. Conclusion The higher values of WHZ standard deviations in infants suggest that declining prevalence in overweight and wasting by age may be possibly due to measurement error or rapid crossing of growth channels by infants.

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Subnational mortality estimates for India in 2019: a baseline for evaluating excess deaths due to the COVID-19 pandemic

BMJ Global Health ◽

10.1136/bmjgh-2021-007399 ◽

2021 ◽

Vol 6 (11) ◽

pp. e007399

Author(s):

Chalapati Rao ◽

Amrit Jose John ◽

Ajit Kumar Yadav ◽

Mansha Siraj

Keyword(s):

Excess Mortality ◽

National Level ◽

Age Groups ◽

Uttar Pradesh ◽

The Elderly ◽

Registration System ◽

Infant Deaths ◽

Civil Registration ◽

The Impact ◽

Mortality Estimates

BackgroundEstimates of excess mortality are required to assess and compare the impact of the COVID-19 pandemic across populations. For India, reliable baseline prepandemic mortality patterns at national and subnational level are necessary for such assessments. However, available data from the Civil Registration System (CRS) is affected by incompleteness of death recording that varies by sex, age and location.MethodsUnder-reporting of CRS 2019 deaths was assessed for three age groups (< 5 years, 15–59 years and ≥60 years) at subnational level, through comparison with age-specific death rates from alternate sources. Age-specific corrections for under-reporting were applied to derive adjusted death counts by sex for each location. These were used to compute life expectancy (LE) at birth by sex in 2019, which were compared with subnational LEs from the Global Burden of Disease (GBD) 2019 Study.ResultsA total of 9.92 million deaths (95% UI 9.70 to 10.02) were estimated across India in 2019, about 2.28 million more than CRS reports. Adjustments to under-five and elderly mortality accounted for 30% and 56% of additional deaths, respectively. Adjustments in Bihar, Jharkhand, Madhya Pradesh, Maharashtra, Rajasthan and Uttar Pradesh accounted for 75% of all additional deaths. Adjusted LEs were below corresponding GBD estimates by ≥2 years for males at national level and in 20 states, and by ≥1 year for females in 12 states.ConclusionsThese results represent the first-ever subnational mortality estimates for India derived from CRS reported deaths, and serve as a baseline for assessing excess mortality from the COVID-19 pandemic. Adjusted life expectancies indicate higher mortality patterns in India than previously perceived. Under-reporting of infant deaths and those among women and the elderly is evident in many locations. Further CRS strengthening is required to improve the empirical basis for local mortality measurement across the country.

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Association between Attitude towards Wife Beating and Childhood Diarrhea: A Demographic and Health Survey-Based Study in 25 Sub-Saharan African Countries

The Scientific World JOURNAL ◽

10.1155/2021/4870994 ◽

2021 ◽

Vol 2021 ◽

pp. 1-11

Author(s):

Betregiorgis Zegeye ◽

Mpho Keetile ◽

Bright Opoku Ahinkorah ◽

Edward Kwabena Ameyaw ◽

Abdul-Aziz Seidu ◽

...

Keyword(s):

Married Women ◽

Sub Saharan Africa ◽

Wife Beating ◽

Demographic And Health Surveys ◽

Women Empowerment ◽

Childhood Diarrhea ◽

Under Five ◽

Under Five Children ◽

Study Results ◽

Sub Saharan

Background. Childhood diarrhea remains a major public health problem in sub-Saharan Africa (SSA). Women empowerment reduces child mortality, and wife beating attitude is one of the indicators of women empowerment. There is a dearth of evidence about wife beating attitudes and childhood diarrhea in SSA. Therefore, the present study aimed to examine the association between attitude towards wife beating and diarrhea among under-five children. Methods. We used Demographic and Health Surveys from 25 countries in SSA that were conducted between 2010 and 2020. Using Stata version 14 software, we carried out the analysis on 153,864 children under five. Bivariate and multivariate logistic regression analyses were applied, and the results were presented using adjusted odd ratios (aOR) at 95% confidence interval (CI). Results. The pooled results show that 71.4% of married women disagreed with wife beating. About 20.5% of under-five children of married women had diarrhea. Childhood diarrhea varied from highest prevalence in Chad (27.9%) to the lowest prevalence in Sierra-Leone (8.5%). The study showed lower odds of diarrhea among children of married women who disagreed with wife beating (aOR = 0.66 95% CI; 0.54–0.80) compared to children of married women who agreed with wife beating. Moreover, the study results show that women’s age (35–39 years-aOR = 0.48, 95% CI; 0.31–0.74, 40–44 years-aOR = 0.57, 95% CI; 0.35–0.93, 45–49 years-aOR = 0.35, 95% CI; 0.16–0.79) was negatively associated with childhood diarrhea, while husband’s education (primary school-aOR = 1.36, 95% CI; 1.05–1.77), parity (ever born 3-4 children-aOR = 1.36, 95% CI; 1.09–1.70, and 5+ children-aOR = 1.56, 95% CI; 1.14–2.12), and religion (Muslim-aOR = 3.56, 95% CI; 1.44–8.83) were positively associated with diarrhea among under-five children. Conclusions. The study shows association between women attitude towards wife beating and childhood diarrhea. Therefore, empowering women, especially young women by increasing awareness about domestic violence, their rights, and empowering them through education and economic advancement need to be considered in order to reduce childhood diarrhea. Moreover, fertility control or birth spacing and working closely with religious leaders are important factors to consider in reducing childhood diarrhea.

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Childhood mortality and Child nutritional status of Bangladesh: A review on Demographic and Health Survey

Journal of Current and Advance Medical Research ◽

10.3329/jcamr.v2i2.24878 ◽

2015 ◽

Vol 2 (2) ◽

pp. 42-46 ◽

Cited By ~ 1

Author(s):

Akkur Chandra Das

Keyword(s):

Comparative Analysis ◽

Nutritional Status ◽

Health Surveys ◽

Mortality Rates ◽

Childhood Mortality ◽

Demographic And Health Surveys ◽

Under Five ◽

The Past ◽

The World ◽

Child Nutritional Status

Background: Childhood mortality and child nutritional status of the developing countries are very much concerning issues of the world. Objective: The objective of this study was to evaluate the situation of childhood mortality and child nutritional status of Bangladesh with the comparative analysis and progress of childhood mortality and child nutritional status from 1993 to 2014. Methodology: In this regard this paper reviews the Bangladesh Demographic and Health Surveys (BDHS) conducted in 1993-94, 1996-97, 1999-2000, 2004, 2007, 2011 and 2014, which were analyzed on infant, child, under-five mortality and child nutritional status in detail. Result: The evidences reflected in BDHSs show that infant, child and under-five mortality in Bangladesh have declined steadily at least over the past years. However, differentials in trends and patterns of childhood mortality and even child nutritional status by the demographic determinants have not been explained elaborately. According to the 1993-1994 and the 2014 surveys found infant mortality two times, child mortality sex times and under-five mortality rates three times declined in 2014 than those were in 1993-94. On the contrary, stunning, wasting and underweight are also declined in 2014 comparatively than the last two decades but it is noted that wasting situation is not gradually declined. Conclusion: Bangladesh successfully declined the total number of childhood mortalities and nutrition related mortalities and complexities. Many non-government and government funded organizations should run some effective programs to overcome the situation completely in Bangladesh.Journal of Current and Advance Medical Research, 2015;2(2):42-46

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