Analysis on Children's Health Equity in Countries along the"Belt and Road"Based on Concentration Index and Thiel Index / 中国卫生经济

Objective:To analyze and evaluate the equity of children's health in countries along the"the Belt and Road",promote further attention to children's health in countries along the route,and promote cooperation and exchanges on children's health between China and countries along the"the Belt and Road".Methods:Using concentration index and concentration curve to measure overall equity,and using the Thiel index for intraregional and interregional euqity measurement.Results:The under-five mortality concentration index is 0.349 7,the concentration curve is below the absolute fair line.The Thiel index shows that inequality in low-income countries,lower-middle-income countries,upper-middle-income countries and high-income countries is the leading cause of child health inequities in the"the Belt and Road"countries.Conclusion:There is inequity in the health of children in countries along"the Belt and Road Initiative",countries along the"the Belt and Road"should take comprehensive measures to reduce the under-five mortality rate,at the same time strengthen international cooperation to further promote equity in children's health in"Belt and Road"countries.

Impact of Air Pollution on Child Health in India and the Way Forward

Recent research in epidemiological modelling reveals that air pollution affects child health in various ways resulting in low birthweight, stillbirth, preterm birth, developmental delay, growth failure, poor respiratory and cardiovascular health, and a higher risk of anemia. India has embarked on the national clean air program, but a much stronger coordinated multi-sectoral approach is required to minimize the child health burden caused by air pollution. Air pollution should be treated as a public health crisis that can only be managed with policy backed by science, gradual transition to clean energy use, emission reduction supported by clean air technologies, long-term commitment from the Government, and cooperation of the citizens.

The effects of Ghana's capitation policy on hospital Under-5 mortality in the Ashanti Region

Objective: The study estimated the capitation policy's effect on the under-5 mortality (U5MR) rate in hospitals in Ashanti Region. Design: We used an interrupted time series design to estimate the impact from secondary data obtained from the DHIMS-2 database. Monthly under-5 deaths and the number of live births per month were extracted and entered into Stata 15.0 for analyses. The U5MR was calculated by dividing the number of live deaths by the number of live births for each of the 60 months of the study. Setting: Health facilities of the Ashanti Region with Data in the DHIMS 2. Intervention: the level and trend of U5MR for 31 months during the Capitation Policy implementation (January 2015 to July 2017) were compared with the level and trend 29 months after the withdrawal of the capitation policy (August 2017 to December 2019). Outcome measures: changes in trend or level of U5MR after the withdrawal of capitation. Main Results: During the capitation policy, monthly U5MR averaged 10.71 +/-2.71 per 1000 live births. It declined to 0.03 deaths per 1000 live births (p=0.65). After the policy withdrawal, the immediate (increase of 0.01 per 1000live births) and the trend (decline of 0.13 deaths per 1000 live births per month) were still not statistically significant. Conclusion: We conclude that the capitation policy did not appear to have influenced under-5 mortality in the Ashanti Region. The design of future healthcare payment models should target quality improvement to reduce under-5 mortalities

A time series analysis on under 5 mortality rate in Zhejiang Province / 预防医学

Objective To study the temporal distribution regular pattern of under 5 mortality rate(U5MR)from 1 998 to 201 4 in Zhejiang Province,and to predict the under 5 mortality rate in 201 5.Methods A time series ARIMA (p,d,q) forecasting model for U5MR was conducted using IBM SPSS Statistics 20.0 statistical analysis software.Results The UMAR showed downward trend.The ARIMA(2,1 ,2)model of U5MR from 1 998 to 201 4 in Zhejiang Province is yt =-0.696 +0.636yt -1 +0.024yt -2 +0.340yt -3 +αt -0.003αt -1 +0.997αt -2 ,and the model fitting was good.Each of the actual mortality was consistent with the trend of model prediction,and was within the 95% confidence interval.The predicted value of U5MR was 4.08‰ (95% CI:1 .52‰ -6.64‰)in 201 5.Conclusion Time series analysis is an effective way to analyze the temporal distribution regular pattern of U5MR,which could be used for short -term prediction.

Maternal Practices Affecting Under-Five Mortality in a Suburban Area of Jos, North-Central Nigeria.

Background: The report of the Population Reference Bureau (2011) which stated that 76 out of every 1,000 infants die every year due to preventable causes like malaria, diarrhea and vaccine preventable diseases in sub-Saharan Africa is worrisome. Whereas, in advanced countries, infant mortality rate has dropped significantly to only five out of every 1,000 live birth. This is what has prompted this study -to determine the predictors of under-five mortality in a suburban area in Jos Plateau State Nigeria. Methods: The study was a community based cross-sectional survey in which households were selected by systematic sampling method from a randomly selected suburban community in Jos, Nigeria Results: The percentage prevalence of reported under-five mortality was found to be 10.8% with the cause of death being reported as malaria (48.4%), diarrhea (38.7%), pneumonia (9.7%) and unknown causes (3.2%), the positive predictors with significant under-five mortality were; high parity with odds of 3.3 times and p value of 0.001 in those with parity of 4-6 and about 16 times mortality with a p value of < 0.000 in those with parity greater than 6. Those who were not exclusively breastfed had 5.3 times the likelihood of mortality with a p value of 0.001 and mortality was 4 times higher in partially immunized children( p=0.027) and almost 12 times in those who were not immunized at all (p< 0.000) Conclusion: Percentage prevalence of reported under-five mortality was found to be higher among those with higher parity, lack of exclusive breastfeeding and poor immunization status in this study.

Avances en los Objetivos de Desarrollo del Milenio 4 y 5 en Mesoamérica / Progress on the Millenium Development Goals 4 and 5 in Mesoamerica

OBJETIVOS: Presentar los avances realizados en la región mesoamericana en relación con los Objetivos de Desarrollo del Milenio 4 y 5 por medio de su análisis y discutir las intervenciones más relevantes para ayudar en el logro de estos objetivos o, por lo menos, en mantener su trayectoria. MATERIAL Y MÉTODOS: Se utilizaron como fuentes las estimaciones de 1990-2008 sobre mortalidad en menores de cinco años y materna, las coberturas de vacunación contra difteria, tétanos y tosferina (DTP), atención prenatal y atención del parto por personal calificado, realizadas por el Instituto de la Métrica y Evaluación en Salud y las causas de mortalidad en menores de cinco años, realizadas por el Grupo de Referencia sobre Epidemiología y Salud en la Infancia de la OMS (CHERG). RESULTADOS: La tendencia de la tasa de mortalidad de menores de cinco años (ODM-4) muestra una reducción anual de 4.2% en los últimos 18 años, comparada con la reducción global de 2.1%. En contraste, la tasa de descenso de la mortalidad materna (ODM-5) es muy heterogénea y ninguno de los países de la región alcanzará este objetivo. CONCLUSIÓN: Los esfuerzos realizados por los países en Mesoamérica han sido sustantivos en la reducción de mortalidad en menores de cinco años; sin embargo no han sido suficientes para alcanzar la meta programada por el ODM-5. Aunque la tendencia es correcta, el ritmo de descenso cumplirá parcialmente con los compromisos adquiridos para erradicar la pobreza.

OBJECTIVES: To describe the advances made by countries in the Mesoamerican region towards reaching Millenium Development Goals (MDG) 4 and 5, and discuss the most useful tasks to help the region in accomplishing or keeping track of these objectives. MATERIAL AND METHODS: The trend estimates of maternal and under 5 mortality from 1990 to 2008, the effective coverage of vaccination against diphteria, pertussis and tetanus (DPT), prenatal care and childbirth by qualified personnel were taken from the Institute of Health Metrics and Evaluation (IHME) and the causes of death for children under five were taken from the Children's Health Epidemiology Reference Group of WHO (CHERG). RESULTS: The regional trend in the rate of mortality for children under five (MDG-4) in the last 18 years shows an annual reduction of 4.2%, significantly above the global reduction of 2.1%. This suggests that countries of Mesoamerica will be able to fulfill this objective. In contrast, data for 2008 shows that the rate of reduction of maternal mortality is very heterogeneous and it is unlikely that any of the countries in the region will reach this goal. CONCLUSION: Efforts made by countries in Mesoamerica have been substantial in controlling mortality in children under five years but insufficient to achieve MDG-5. Although the tendency is in the right track the reduction rate will only partially fulfill the acquired commitments to eradicate poverty.

Saneamiento y relación con la salud de la niñez en el contexto mundial 2004 / Sanitation as related to children`s health in the world context 2004

Se determina el efecto mundial de los diferentes tipos de cobertura de disposición de excretas, DE, definidas en el marco del concepto "Instalaciones de Saneamiento Mejoradas", ISM, de OMS y UNICEF, sobre las tasas de mortalidad en niños menores de 5 años, TM menor 5 años. Para lograrlo se recolectaron datos de cobertura de DE en 161 países del "Programa Conjunto de Monitoreo" del 2004. Las TM menor 5 años se obtuvieron del informe "Progreso para la Infancia: un balance sobre agua y saneamiento". Los datos de ISM se clasificaron en totales, ISM-total, alcantarillado, DEA, tanques sépticos y letrinas, DET y L, y sin servicio, DESS. Se aplicaron 3 métodos estadísticos: distribución de frecuencias entre los intervalos de ambas variables, la correlación simple de Pearson entre los tipos de evacuación de excretas y las TM menor 5 años y la correlación Parcial al 95 por ciento de confianza pero controlando variables. Los resultados indican que a mayor cobertura mediante ISM-total menor es la TM menor 5 años, con una correlación de menos 0.782, mientras que las coberturas con DEA tienen mayor impacto sobre la disminución de la mortalidad que cuando se realiza por DET y L. Estos resultados se ratifican con las otras pruebas estadísticas y comprueban la hipótesis.

The worldwide effect on mortality in children under five years of age (MR < 5 years ) is determined for the different types of excreta disposal (ED) coverage, as defined in the framework of "Improved Sanitation Facilities (ISF)", established by the WHO and UNICEF. To accomplish this, ED coverage data was collected from 161 countries participating in the "Joint Monitoring Programme" in 2004. The mortality rates were obtained from "Progress for Children: A Balance on Water and Sanitation". ISF data were classified as: total (total-ISF), sewage (DEA), septic tanks and latrines (DET and L), and without services (DESS). Three statistical methods were applied: frequency distribution between the intervals of both variables, Pearson´s simple correlation between the types of excreta evacuation and the MR<5 years, and partial correlation at 95% confidence but controlling the variables. Results indicate that as total coverage (total-ISF) increases, there is a lower incidence of mortality (MR < 5 years), with a correlation of –0,782; while DEA coverage has a greater impact over mortality decrease as compared to DET and L. The results are ratified with the other statistical tests and prove the hypothesis.

Mortalidad en menores de cinco años mexicanos en 2004: hacia los objetivos del milenio / Mortality in Mexican children under five in 2004: towards meeting the millenium development goals

Introducción. En México, el cumplimiento de los objetivos del milenio (ODM), y en particular el número 4 relativo a la mortalidad en la infancia, tiene múltiples implicaciones. Para disminuir la mortalidad en menores de cinco años de 46 a 15.2 por 1 000 nacidos vivos (nv) se requiere realizar diversas acciones coordinadamente por todas las instituciones que componen el sistema de salud. Material y métodos. Se analizaron estimaciones del Consejo Nacional de Población (CONAPO), así como bases de datos de defunciones 1990-2002, Instituto Nacional de Estadística, Geografía e Informática (INEGI)/Secretaría de Salud y bases de datos de defunciones 2004, INEGI/Secretaría de Salud. Resultados. De acuerdo con las estimaciones del CONAPO en 1990 la mortalidad de menores de 5 años en el Distrito Federal era de 28.4 por 1 000 nv y en Chiapas la cifra ascendía a 65, es decir, 2.3 veces más riesgo de morir de los niños del sur y en 2004 la mortalidad en la infancia del Distrito Federal ha descendido a 14.4 y en Chiapas a 26.3 por 1 000 nv disminuyendo a 1.8 el diferencial de riesgo. No obstante el avance, la cifra alcanzada por Chiapas en 2004 representa un rezago con respecto a lo alcanzado por el Distrito Federal o por Nuevo León de 15 a 18 años. En la actualidad, como causas de mortalidad en menores de 5 años, predominan las afecciones perinatales, las anomalías congénitas y las lesiones accidentales.Aunque ha disminuido de manera considerable la participación de las causas infecciosas, todavía se mantienen dentro de los primeros lugares a nivel nacional. Conclusión. México es de los pocos países que se encuentra en la trayectoria adecuada de descenso de la mortalidad en la infancia. Sin embargo, existen importantes rezagos por resolver y sobre todo desafíos que atender. La compresión de la mortalidad infantil es uno de ellos, o quizás el más importante a encarar en el corto plazo.

Introduction. For Mexico, to achieve the Millennium Development Goals and particularly Goal number 4, relative to fewer than 5 mortality, has multiple implications. In order to reduce under 5 mortality from 46 to 15.2 per 1 000 live births mortality, multiple public health actions have to be undertaken in a coordinated fashion by all of the institutions that conform the National Health System. Materials and methods. Estimates by the National Population Council (CONAPO) were analyzed. The data base of registered deaths compiled by the National Institute for Geography and Health Statistics and the Ministry of Health between 1990-2002 and for 2004 were also reviewed and analyzed. Results. According to CONAPO estimates, in 1990 under 5 mortality in Mexico City (Federal District) was 28.4 per 1 000 live births, while in the State of Chiapas the rate was 65; that is 2.3 times higher risk of dying in this region of the country. In 2004 the figures for these 2 Federal entities had dropped significantly to 14.4 and 26.3 respectively, lowering the difference in risk to 1.8 for the latter, yet still leaving Chiapas in greater risk. At present, the primary causes of under 5 mortality include perinatal causes, congenital malformations, lesions and accidents. Although infectious diseases as a cause of death have been significantly reduced, at a National level, they still appear in the top causes of mortality in children under 5. Conclusion. Mexico is among the few countries in the correct or adequate path for reducing under 5 mortality. Nevertheless, there are still significant obstacles that need to be resolved and challenges to be addressed. The compression of the infant mortality and the gap among states is undoubtedly one of the most important issues to be addressed in the immediate future.