Influence of socio-demographic and environmental factors on child mortality in India

Background: According to National Family Health Survey (NFHS) report (round 5), under five child mortality rate is 42 per 1000 live births which is far behind the sustainable development goal and National Health Policy, 2017. This research work aims to investigate the socio-demographic and environmental risk factors associated with child mortality between age 0-59 months in India. Methods: To analyse the objective of this study secondary data of NFHS round 5 are used. NFHS is a large scale, multi-rounds survey conducted by ministry of Health and Family Welfare (MoHFW) with the collaboration of International Institute for Population Sciences (IIPS), Mumbai. Cox regression model is used for the statistical analysis and the data analysis work is carried out using R software. Results: The research found that mortality rate is higher among mother’s age less than 20 years and mother’s having no education. In rural areas mortality rate is high compared to urban residence. Birth order of child more than 6 has 2.0966 times higher risk to die and the male child is more likely die than the female. Children born to family having richest wealth index (HR=0.6550, CI: 0.5856-0.7327) has the least mortality rate. Use of polluting cooking fuel and unimproved sanitation facility increase death risk on under-five mortality 1.1334 times and 1.0905 times respectively. Conclusions: The study found a strong influence of socio-demographic and environmental factors on child mortality under the age of five.

Factors Affecting Under-Five Mortality Rate (U5MR) in India- National Family Health Survey (NFHS) 5 Factsheet What It Speaks?

Introduction: In developing countries various factors lead to Under-5 Mortality and irreversible losses which can be prevented by proper measures take on factors affecting to it. Objective: This study was conducted to analyse the changing trends of Under-5 Mortality in India. The new National Family Health Survey (5th round) which was published recently came up with several new findings, which were both encouraging and disheartening and also one of the major Sustainable Development Goals.Method: A secondary data analysis was conducted of NFHS factsheets to study the U5MR in India. The indica-tors which had a correlation either positive or negative with the Under-five mortality rate were included.Result- When we look at the result, few states' performance is encouraging because they have shown some of the best declines. Correlation was found between dependant variable that is U5MR which is a dependent vari-able and several independent variables which concluded that factors like Women literacy, Men literacy, Breastfeeding, Nutritional insufficiencies, Caesarean delivery, ANC visits and IFA consumptions are negatively associated withU5MR. Conclusion: Various steps have been taken in order to improve our healthcare sector since independence, every government had their fair share of contribution, that’s the reason why we are this stage. Now it’s time to increase efforts with targeted interventions to solve this problem and complete our commitment towards the SDGs.

Antenatal care services in decreasing under-five mortality / Serviços de cuidados pré-natais na redução da mortalidade de menores de cinco anos

Abstract Objectives: the first five years of life are critical for children's physical and intellectual development. However, the under-five mortality rate in South Asia and ASEAN is relatively high, caused by complex etiologies. This paper identifies maternal high-risk fertility behaviors and healthcare services utilization and examines predictors of under-five mortality (U5M) in 7 Asian (South Asia - ASEAN) developing countries (Indonesia, Myanmar, Cambodia, Philippines, Bangladesh, Nepal, and Pakistan). Methods: a multivariate logistic regression model with a complex survey was used to examine predictors of U5M on the frequency of U5M adjusted for comorbidities. Results: according to multivariate models (model 2), U5M was 2.99 times higher in mothers with low weight at birth infants than in mothers without low weight at birth infants (aOR= 2.99; CI95%=2.49-3.58); Mothers without antenatal care contacts were 3.37 times more likely (aOR= 3.37; CI95%=2.83-4.00) to have a U5M than mothers with eight or more antenatal care contacts; U5M in Indonesia was 2.34 times higher (aOR= 2.34; CI95%= 1.89-2.89). It is investigated that antenatal care serves as a predictor in decreasing U5MR. Conclusions: in order to achieve significant U5MR reduction, intervention programs that encourage antenatal care consultations should be implemented.

Resumo Objetivos: os primeiros cinco anos de vida são críticos para o desenvolvimento físico e intelectual da criança. No entanto, a taxa de mortalidade de menores de cinco anos no sul da Ásia e na ASEAN é relativamente alta, causada por etiologias complexas. Este artigo identifica comportamentos maternos de fertilidade de alto risco e utilização de serviços de saúde e examina preditores de mortalidade abaixo de 5 anos (MM5) em 7 países em desenvolvimento da Ásia (Sul da Ásia - ASEAN) (Indonésia, Mianmar, Camboja, Filipinas, Bangladesh, Nepal e Paquistão). Métodos: um modelo de regressão logística multivariada foi usado para examinar preditores de MM5 na frequência de MM5 ajustado para comorbidades. Resultados: na análise multivariada (modelo 2), U5M foi 2,99 vezes maior em mães com bebês com baixo peso ao nascer do que em mães sem bebês com baixo peso ao nascer (aOR= 2,99; IC95%=2,49-3,58); as mães sem contatos de cuidados pré-natais tiveram 3,37 vezes mais probabilidade (aOR=3,37; IC95%=2,83-4,00) para ter MM5 do que mães com oito ou mais contatos de cuidados pré-natais; MM5 na Indonésia foi 2,34 vezes maior (aOR= 2,34; IC95%= 1,89-2,89). Investiga-se que os cuidados pré-natais funcionam como um preditor na diminuição da MM5. Conclusões: para uma redução significativa da MM5, devem ser implementados programas de intervenção que estimulem as consultas pré-natais.

Multilevel Survival Analysis of Factors Associated with Under-Five Mortality in Manipur

Background: Child mortality is a major public health issue. The studies on under‑five mortality that ignore the hierarchical facts mislead the interpretation of the results due to observations in the same cluster sharing common cluster‑level random effects. Objectives: The present study uses a multilevel model to analyze under‑five mortality and identify the significant factors for under‑five mortality in Manipur. Methods: National Family Health Survey‑5 (2019–21) data are used in the present study. Amultilevel mixed‑effect Weibull parameter survival model was fitted to determine the factors affecting under‑five mortality. We construct three‑level data, individual levels are nested within primary sampling units (PSUs), and PSUs are nested within districts. Results: Out of the 3225 under‑five children, 85 (2.64%) died. The three‑level mixed‑effects Weibull parametric survival model with PSUs nested within the districts, the likelihood‑ratio test with Chi‑square value = 10.98 and P = 0.004 < 0.05 indicated that the model with random‑intercept effects model with PSUs nested within the districts fits the data better than the fixed effect model. The four covariates, namely the number of birth in the last 5 years, age of mother at first birth, use of contraceptive, and size of child at birth, were found as the risk factor for under‑five mortality at a 5% level of significance. Conclusions: In the random‑intercept effect model, the two estimated variances of the random‑intercept effects for district and PSU levels are 0.27 and 0.31, respectively. The values indicate variations (unobserved heterogeneities) in the risk of death of the under‑five children between districts and PSUs levels.

Towards data-driven models for diverging emerging technologies for maternal,neonatal and child health services in Sub-Saharan Africa:a systematic review / 《全球健康杂志（英文）》

Sub-Saharan Africa(SSA)has the highest maternal and under-five mortality rates in the world.The advent of the coronavirus disease 2019 exacerbated the region's problems by overwhelming the health systems and affecting access to healthcare through travel restrictions and rechanelling of resources towards the containment of the pandemic.The region failed to achieve the Millenium Development Goals on maternal and child mortalities,and is poised to fail to achieve the same goals in the Sustainable Development Goals.To improve on the maternal and child health outcomes,many SSA countries introduced digital technologies for educating pregnant and nurs-ing women,making doctors'appointments and sending reminders to mothers and expectant mothers,as well as capturing information about patients and their illnesses.However,the collected epidemiological data are not being utilised to inform patient care and improve on the quality,efficiency and access to maternal,neonatal and child health(MNCH)care.To the researchers'best knowledge,no review paper has been published that focuses on digital health for MNCH care in SSA and proposes data-driven approaches to the same.Therefore,this study sought to:(1)identify digital systems for MNCH in SSA;(2)identify the applicability and weaknesses of the dig-ital MNCH systems in SSA;and(3)propose a data-driven model for diverging emerging technologies into MNCH services in SSA to make better use of data to improve MNCH care coverage,efficiency and quality.The PRISMA methodology was used in this study.The study revealed that there are no data-driven models for monitoring pregnant women and under-five children in Sub-Saharan Africa,with the available digital health technologies mainly based on SMS and websites.Thus,the current digital health systems in SSA do not support real-time,ubiquitous,pervasive and data-driven healthcare.Their main applicability is in non-real-time pregnancy moni-toring,education and information dissemination.Unless new and more effective approaches are implemented,SSA might remain with the highest and unacceptable maternal and under-five mortality rates globally.The study proposes feasible emerging technologies that can be used to provide data-driven healthcare for MNCH in SSA,and the recommendations on how to make the transition successful as well as the lessons learn from other regions.

Household air pollution and under-five mortality in sub-Saharan Africa: an analysis of 14 demographic and health surveys

BACKGROUND@#Globally, over four million deaths are attributed to exposure to household air pollution (HAP) annually. Evidence of the association between exposure to HAP and under-five mortality in sub-Saharan Africa (SSA) is insufficient. We assessed the association between exposure to HAP and under-five mortality risk in 14 SSA countries.@*METHODS@#We pooled Demographic and Health Survey (DHS) data from 14 SSA countries (N = 164376) collected between 2015 and 2018. We defined exposure to HAP as the use of biomass fuel for cooking in the household. Under-five mortality was defined as deaths before age five. Data were analyzed using mixed effects logistic regression models.@*RESULTS@#Of the study population, 73% were exposed to HAP and under-five mortality was observed in 5%. HAP exposure was associated with under-five mortality, adjusted odds ratio (OR) 1.33 (95% confidence interval (CI) [1.03-1.71]). Children from households who cooked inside the home had higher risk of under-five mortality compared to households that cooked in separate buildings [0.85 (0.73-0.98)] or outside [0.75 (0.64-0.87)]. Lower risk of under-five mortality was also observed in breastfed children [0.09 (0.05-0.18)] compared to non-breastfed children.@*CONCLUSIONS@#HAP exposure may be associated with an increased risk of under-five mortality in sub-Saharan Africa. More carefully designed longitudinal studies are required to contribute to these findings. In addition, awareness campaigns on the effects of HAP exposure and interventions to reduce the use of biomass fuels are required in SSA.

Vaccination coverage and its determinants in rural areas of district Doda of Jammu and Kashmir, India

Background: India accounts for the highest number of under-five deaths in the world. Estimates claim that 89 lakh children in India receive fewer vaccines or no vaccine at all. One out of every three children in India does not receive all vaccines under the universal immunization programme. 5% children in urban and 8% children in rural areas remain unimmunized. According to NFHS-4 data complete vaccination coverage in India stands at 62%. The objectives of this study were to evaluate complete vaccination coverage, dropout rate and identify factors for failure of vaccination coverage in Doda district of Jammu and Kashmir, state of India.Methods: A cross-sectional quantitative study was conducted to evaluate the complete vaccination coverage by using an interview schedule devised as per WHO-UNICEF coverage cluster survey reference manual and National Immunization Schedule. A pre-determined sample size according to the WHO-UNICEF coverage cluster survey reference manual was adopted for the purpose of the study.Results: Of the total 207 children included in the study 66.2% (n=137) were fully immunized. 19.8% of the children had dropped out and did not receive the recommended dose of pentavalent vaccine. Among the reasons for low complete vaccination coverage, lack of awareness, mother too busy and vaccinator being absent were identified as the major reasons.Conclusions: Complete vaccination coverage has shown an increase with an increase in the coverage of the individual vaccines. But the coverage is still low and more efforts are needed to further improve the vaccination coverage.

Factors Related to Deaths of under 5 Years Old Children in Dar Alsalam Area-Khartoum-Sudan

Aims: This study is done to identify factors affecting under five mortality in Dar Alsalam area, Khartoum.Study Design:This is a community based cross-sectional study.Place and Duration of Study:The study was carried out in block 25 in Dar Alsalam area in Khartoum State during March-April 2012.Methodology: A total of 240 women in reproductive age who had an experienceof child death were interviewed. The data was collected by semi-final medical students using structured questionnaire. Two stage cluster sampling was used to select the households. Data was summarized using descriptive statistics and logistic regression analysis was carried out to identify factors associated with under-five mortality.Results: Age of 156 (65%) of the deceased children was less than one year, while the age of 84 (35%) was between one and five years. The age of (25%) of the motherat the time of their child birth was below 18 years. The majority of the mothers (70.8%) were illiterate, 74.2% were working and 80% were married. Of the children 51.7 were males and for 74.2% of them the birth interval was less than 2 years. Only 16.7% were breast fed for more than two years while the rest (83.3%) were breast fed up to 2years. Only 34.2% of the deceased children had completed their vaccination, and 68.3% had been admitted to hospital more than once before death.Half of the families have piped water in their houses, in 75.8% of the houses there are pit latrines andin68.3% there is electricity supply. Logistic regression analysis identified incomplete vaccination, not employed mothers and having no latrines in the house as the factors related to the death of children between 1-5 years than those below one year.Conclusion: Under-five mortality in low socioeconomic areas is associated with Low family income, mother’s illiteracy, early marriage and absence of latrines in the houses.

Unmet Need for Family Planning: Implication for Under-five Mortality in Nigeria.

There are gaps in evidence on whether unmet need for family planning has any implication for under-five mortality in Nigeria.This study utilized 2008 Nigeria Demographic and Health Survey data to examine the effect of unmet need on under-five mortality. Cox regression analysis was performed on 28,647 children born by a nationally-representative sample of 18,028 women within the five years preceding the survey. Findings indicated elevated risks of under-five death for children whose mothers had unmet need for spacing [Hazard ratio (HR): 1.60, confidence interval (CI) 1.37-1.86, p<0.001] and children whose mothers had unmet need for limiting (HR: 1.78, CI 1.48-2.15, p<0.001) compared to children whose mothers had met need. These findings were consistent after adjusting for the effects of factors that could confound the association. Findings of this study underscore the need to address the present level of unmet need for family planning in Nigeria, if the country would achieve meaningful reduction in under-five mortality.

Food & nutrition security: Challenges in the new millennium.

The World Food Summit in 1996 provided a comprehensive definition for food security which brings into focus the linkage between food, nutrition and health. India has been self sufficient in food production since seventies and low household hunger rates. India compares well with developing countries with similar health profile in terms of infant mortality rate (IMR) and under five mortality rate (U5 MR). India fares poorly when underweight in under five children is used as an indicator for food insecurity with rates comparable to that of Subsaharan Africa. If wasting [low body mass index (BMI) for age in children and low BMI in adults] which is closely related to adequacy of current food intake is used as an indictor for the assessment of household food security, India fares better. The nineties witnessed the emergence of dual nutrition burden with persistent inadequate dietary intake and undernutrition on one side and low physical activity / food intake above requirements and overnutrition on the other side. Body size and physical activity levels are two major determinants of human nutrient requirements. The revised recommended dietary allowances (RDA) for Indians takes cognisance of the current body weight and physical activity while computing the energy and nutrient requirements. As both under- and overnutrition are associated with health hazards, perhaps time has come for use of normal BMI as an indicator for food security.

Nutrition and child survival in India.

India recognized the importance of improving the health and nutritional status of children, and initiated steps to improve access to nutrition and health services soon after independence. Over the years, the infrastructure and human resources for manning the health and nutrition services have been built up and currently cover the entire country. However these are inadequacies in terms of content and quality of services and undernutrition rates and under five morality rates continue to be high. Undernutrition begins in utero, and with low birthweight, effective antenatal care can help in reducing low birth weight. The poor infant and young child feeding (IYCF) practices, repeated morbidity due to infections and poor utilization of health and nutrition services are other causes of undernutrition in children in India. The key intervention to prevent undernutrition is nutritional and health education through all modes of communication, to bring about is a behavioral change towards appropriate IYCF and utilization of health care. Appropriate convergence and synergy between health and nutrition functionaries can play a major role in early detection and effective management of both undernutrition and infections, accelerate the pace of reduction in both undernutrition and under five mortality and enable India to reach Millennium Development Goals.