Clinical Profile and Outcomes of Children with Acute Liver Failure in a Tertiary Care Center in South India: A Retrospective Study.

Purpose: In this study, we investigated the clinical profile, survival at discharge, and proportion of children with acute liver failure (ALF) meeting the criteria for, yet surviving without, liver transplantation (LT). Methods: Medical case records of children aged >28 days to ≤15 years over a period of 7 years, identified from pediatric admission and discharge registers, were screened. Children satisfying the criteria for ALF were included in this study. Results: A total of 71 records meeting the pediatric ALF (PALF) criteria were included. The survival rate at discharge was 61% (n=44). A considerable proportion of children satisfied the King's College Criteria (KCC) (56.3%) and the European Association for the Study of the Liver (EASL) criteria (7%) for LT at admission. Nonetheless, the survival rate in the absence of LT was 42.5% in children who satisfied the KCC and 20% in those who met the EASL criteria. Infection (29.5%) and paracetamol overdose (19.7%) were the major identifiable causes of PALF. Hepatitis A was the most common infection identified. No significant predictors of poor outcomes were identified in multivariable analysis. Conclusion: Our study highlights the changing survival rates and the clinical and etiological profiles of patients with PALF. In areas with poor access to LT services, survival in these children could be improved through early referral to centers with adequate intensive care facilities. Preventing ALF and referring patients to LT services are paramount to reducing mortality.

Determinants of child survival practice among caregivers in internally displaced persons' camps in Abuja Municipal Area Council, Nigeria.

BACKGROUND: Child survival remains a major public health challenge in the sub-Saharan region of Africa, especially Nigeria. The Boko Haram crisis, which has aggravated this, has led to the displacement of many people in the north-eastern region, including children under five. This study investigated the determinants of child survival practice among caregivers in internally displaced persons' (IDP) camps in Abuja Municipal Area Council (AMAC), Nigeria. METHODOLOGY: A cross-sectional design was used to collect data on determinants of child survival practice from 312 caregivers in five purposively selected IDP camps in AMAC using the snowball sampling technique. Data were analysed using univariate, bivariate, and multivariate statistics at 5% level of significance. RESULTS: The mean age of respondents was 29.6 ± 6.72 years. There was a significant (p < 0.05) relationship between the predisposing, reinforcing, enabling and environmental factors studied and child survival practice. Findings also indicated that all factors were significant (p < 0.05) predictors of child survival practice with the reinforcing factor being the major predictor (ß = 0.38; t = 6.08). CONCLUSION: Attention needs to be paid to all factors, particularly the reinforcing factor of social support in order to promote optimal child survival practice among caregivers in AMAC IDP camps. Collaboration with social work professionals would be an added benefit to enhance social support.

Pre-Conceptional and Antenatal Care for Improved Newborn and Child Survival in India: A Review.

There is sufficient scientific evidence that quality pre-conceptional care and antenatal care can improve newborn survival. This review was conducted to understand the concept of pre-conceptional care and its implementation status in India. The review documents the specific interventions that have been proven to effectively improve pregnancy outcome when provided as pre-conception care. Healthcare providers, particularly obstetricians/gynecologists and general physicians, should prioritize pre-conception care as an essential component of healthcare for women. However, the lack of continuum of care and program linkages are some of the key barriers in ensuring pre-conceptional and ante-natal care in India. Culturally and linguistically appropriate care should be provided to ensure that all women can access and understand the information and services needed to optimize their reproductive health and improve pregnancy outcomes. Prioritizing pre-conception and prenatal care, healthcare providers can improve maternal and fetal outcomes, reduce healthcare costs, and promote lifelong health for women and their families. The primary healthcare reforms being done in India can be and should be used to strengthen pre-conceptional and ante-natal care services and quality.

Adult mortality patterns in Yemen before and during armed conflict: evidence from a web survey of the global diaspora.

BACKGROUND: The ongoing war in Yemen has created a severe and protracted crisis that has left nearly three-quarters of the population in need of urgent humanitarian assistance. Despite eight years of conflict there exist few robust estimates of how the conflict (and the conflict combined with the COVID-19 pandemic) have affected mortality in Yemen. As the security situation has limited access to affected populations we have designed a novel alternative to local mortality surveys. METHODS: We used a web-based, respondent-driven sampling method to disseminate a mortality survey amongst the global Yemeni diaspora. We used Cox proportional hazards survival models to estimate the association between the exposure (i.e. between the pre-conflict, conflict, and conflict/pandemic periods) and mortality risk, adjusted for gender and birth cohort. RESULTS: Eighty-nine eligible respondents completed the survey. Respondents provided data on the status of 1704 individuals of whom 85 (5%) had died; of these 65 (3.8%) were reported to have died in Yemen. An analysis of survivorship of respondents' parents after their 50th birthday (adjusted for gender and birth cohort) provided weak evidence that the war and pandemic periods were associated with higher mortality when compared to the pre-war period. Analysis of the subset of individuals who died in Yemen also suggested an increased, but non-significant hazard of dying during the war/pandemic period: this association tended towards significance when allowing for varying degrees of out-migration from Yemen across the cohort. The number of deaths amongst respondents' siblings and children under five in Yemen were too low to allow meaningful analysis. CONCLUSIONS: Our data suggest increased mortality during the war/pandemic period, compared to the pre-war period, among older Yemeni adults. However, our findings require careful interpretation as our study design cannot establish causation, and as our small and non-representative sample appeared skewed towards higher-income, urban communities. Surveys of diaspora populations offer a promising means of describing mortality patterns in crisis-affected populations; though, large numbers of respondents are likely required to achieve accurate mortality estimates and to adjust for selection bias.

Measles vaccination and reduced child mortality: Prevention of immune amnesia or beneficial non-specific effects of measles vaccine?

Measles vaccine (MV) has been observed to reduce all-cause mortality more than explained by prevention of measles infection. Recently, prevention of "measles-induced immune amnesia" (MIA) has been proposed as an explanation for this larger-than-anticipated beneficial effect of measles vaccine (MV). According to the "MIA hypothesis", immune amnesia leads to excess non-measles morbidity and mortality, that may last up to five years after measles infection, but may be prevented by MV. However, the benefits of MV-vaccinated children could also be due to beneficial non-specific effects (NSEs) of MV, reducing the risk of non-measles infections (The "NSE hypothesis"). The epidemiological studies do provide some support for MIA, as exposure to measles infection before 6 months of age causes long-term MIA, and over 6 months of age for 2-3 months. However, in children over 6 months of age, the MIA hypothesis is contradicted by several epidemiological patterns: First, in community studies that adjusted for MV status, children surviving acute measles infection had lower mortality than uninfected controls (44%(95%CI: 0-69%)). Second, in six randomised trials and six observational studies comparing MV-vaccinated and MV-unvaccinated children, the benefit of MV changed minimally from 54%(43-63%) to 49%(37-59%) when measles cases were censored in the survival analysis, making it unlikely that prevention of measles and its long-term consequences explained much of the reduced mortality. Third, several studies conducted in measles-free contexts still showed significantly lower mortality after MV (55%(40-67%)). Fourth, administration of MV in the presence of maternal measles antibody (MatAb) is associated with much stronger beneficial effect for child survival than administration of MV in the absence of MatAb (55%(35-68%) lower mortality). The MIA hypothesis alone cannot explain the strongly beneficial effects of MV on child survival. Conversely, the hypothesis that MV has beneficial non-specific immune training effects is compatible with all available data. Consideration should be given to continuing MV even when measles has been eradicated.

Breastfeeding and female labor force participation: the probability of survival of children in Nepal under 3 years old.

BACKGROUND: The number of breastfeeding mothers participating in a labor force to generate income has been increasing in Nepal. In this regard, the study aims to assess the survival of Under 3 children in Nepal from the mother based on their labor force participation and breastfeeding status. METHODS: Data for the study were obtained from the Nepal Demographic and Health Survey 2016. The sample size of the study was 2,994 live births children, born in the last three years prior to the day of the interview. The robust hazard ratio and cox proportional hazard regression were conducted between dependent and independent variables with 95% confidence intervals (CIs) to conclude. RESULTS: From a total of 2,994 live births, 85 children died within 36 months of birth. More than 80% of the non-working mothers were breastfeeding their children. The findings shows that the survival of children under-3 is positively associated with the interaction with the mother's work and breastfeeding status (Hazard Ratio 0.428, 95% CI 0.24, 0.75), family structure (Hazard Ratio 1.511; 95% CI 1.37, 1.655), relationship with the household head (Hazard Ratio 0.452; 95% CI 0.311, 0.65), wealth quintiles (Hazard Ratio 0.390; 95% CI 0.33, 0.46), caste (Hazard Ratio 0.652; 95% CI 0.60, 0.69), and religion (Hazard Ratio 2.015; 95% CI 1.09, 3.70) with model CI 95%, Log pseudo likelihood = -521.39236, prob. χ2 = 0.005 and time at risk = 52,748. CONCLUSIONS: The highest rate of child survival was from the working mothers as well as continuing breastfeeding their children followed by mothers breastfeeding the child but not working, compared to mothers working but not breastfeeding the child, and mothers who were neither working nor breastfeeding their children respectively. This study provides clear evidence that breastfeeding is very important for the probability of survival of the child aged below 36 months and work of mother also have some positive impact on child survival. Employers should be encouraged to have a breastfeeding policy in the workplace through the establishment of a breastfeeding facility, and a flexible work schedule. At the same time government should also regulate the paid maternity leave and encourage societal support for the breastfeeding mothers.

Study of dog control strategies.

OBJECTIVES: (1) To explore the relationship between regionally implemented dog control strategies and dog bite injuries (DBIs) and (2) to evaluate current implementation of dog control strategies. METHODS: Observational study using a nationwide online survey of territorial authorities (TAs). Domains of interest included complaints for attacks on people, dog population, primary and secondary prevention strategies, resourcing and perspectives of current strategies. Quantitative variables were compared with DBI Accident Compensation Corporation (ACC) claims by region from 2014 to 2018. RESULTS: Two-thirds of TAs (70%; n=47/67) responded to the survey. No clear relationship was observed between DBIs and: registered dog population, proportion sterilisations or microchipping, classifications due to dog behaviour, or existing limited resourcing. Legislated breeds and infringements for failure to control a dog or non-registration were higher in areas with greater DBIs. Educational messages varied widely and were predominantly victim directed (67%; n=71/106). Complaints for dog attacks on people were lower than DBIs in most areas, with no formal cross-agency notification policies. Few prosecutions or dog destruction orders were made. CONCLUSIONS: Regional inequity in DBIs could not be explained by differences in the registered dog population or dog control strategies. Minimal and inequitable resourcing exists to implement current dog control strategies and provide owner-directed education. Gaps in legislation include environmental barrier requirements for all dogs (leash/muzzle use, adequate fencing), notification of incidents and child protection. Partnership with the Indigenous community (Maori) and other community groups will be required to implement these measures successfully.

Cost-effectiveness of England's national 'Safe At Home' scheme for reducing hospital admissions for unintentional injury in children aged under 5.

BACKGROUND: Injuries in children aged under 5 years most commonly occur in the home and disproportionately affect those living in the most disadvantaged communities. The 'Safe at Home' (SAH) national home safety equipment scheme, which ran in England between 2009 and 2011, has been shown to reduce injury-related hospital admissions, but there is little evidence of cost-effectiveness. MATERIALS AND METHODS: Cost-effectiveness analysis from a health and local government perspective. Measures were the incremental cost-effectiveness ratio per hospital admission averted (ICER) and cost-offset ratio (COR), comparing SAH expenditure to savings in admission expenditure. The study period was split into three periods: T1 (years 0-2, implementation); T2 (years 3-4) and T3 (years 5-6). Analyses were conducted for T2 versus T1 and T3 versus T1. RESULTS: Total cost of SAH was £9 518 066. 202 223 hospital admissions in the children occurred during T1-3, costing £3 320 000. Comparing T3 to T1 SAH reduced admission expenditure by £924 per month per local authority and monthly admission rates by 0.5 per local authority per month compared with control areas. ICER per admission averted was £4209 for T3 versus T1, with a COR of £0.29, suggesting that 29p was returned in savings on admission expenditure for every pound spent on SAH. CONCLUSION: SAH was effective at reducing hospital admissions due to injury and did result in some cost recovery when taking into admissions only. Further analysis of its cost-effectiveness, including emergency healthcare, primary care attendances and wider societal costs, is likely to improve the return on investment further.

Child survival: the role of a mother's education.

In developing countries, children are considered as social and human capital needed for growth and development. However, the ability of uneducated parents to provide basic services to keep a child alive has always been in doubt. This has resulted in the avoidable deaths of children. This study seeks to examine the role of a mother's education in keeping a child alive. This is achieved by using the Ghana Demographic and Health Survey (DHS) Dataset (1988-2014) with 33,896 observations. This study uses the negative binomial model and finds an inverse and statistically highly significant relationship between a mother's education and the survival of her child in Ghana. Further robustness checks confirm that the result is consistent across gender of child and years of data collection. In line with the finding, this study recommends women's education from the basic education level as it drives the probability of saving a life. Globally, we suggest that education, especially at the basic level, should include health education to address numerous health concerns.

Varied Reproductive Histories of Ethnically Tibetan Women.

BACKGROUND: The U.N. health and well-being goals for 2030 focus on maternal and child health outcomes, among others. Challenges to meeting those goals vary widely throughout Nepal owing to the range of sociocultural factors, infrastructural limitations, physical geography and altitudes. This article explores sociocultural and biological influences on fertility and child survival among ethnically Tibetan women in Nepal. METHODS: This is a cross sectional study of 430 women, age 46-86 years old, citizens of Nepal and native residents above 3500m in Mustang District, who provided interview and physiological data. Univariate Poisson regression analyses selected significant variables to include in multivariate Poisson regressions investigating the number of pregnancies, livebirths, child survival and death outcomes. RESULTS: Earlier age at first pregnancy, later age at last pregnancy, and miscarriages associated with more pregnancies. Miscarriages and stillbirths associated with fewer livebirths. Higher maternal BMI and FEV6 associated with fewer children dying before age 15. Marital characteristics (status, type, continuity), contraceptive use, relative wealth, and education influenced these covariates. CONCLUSIONS: Low maternal pulmonary function and nutritional status predict poorer child survival in Upper Mustang. Addressing poor lung function and nutrition may improve reproductive outcomes among ethnically Tibetan women living at high altitude.

The Rotavirus Vaccine Story: From Discovery to the Eventual Control of Rotavirus Disease.

Worldwide, rotavirus is the leading pathogen causing severe diarrhea in children and a major cause of under 5 years mortality. In 1998, the first rotavirus vaccine, RotaShield, was licensed in the United States but a rare adverse event, intussusception, led to its withdrawal. Seven years passed before the next generation of vaccines became available, Rotarix (GSK) and Rotateq (Merck), and 11 years later, 2 additional vaccines from India, Rotavac (Bharat) and Rotasiil (Serum Institute), were recommended by World Health Organization for all children. Today, these vaccines are used in more than 100 countries and have contributed to marked decreases in hospitalizations and deaths from diarrhea. However, these live oral vaccines are less effective in low-income countries with high under 5 years mortality for reasons that are not understood. Efforts to develop new vaccines that avoid the oral route are in progress and will likely be needed to ultimately control rotavirus disease.

Prenatal consultation and survival of children under five in Togo.

INTRODUCTION: Child survival is low in Togo, often linked to socio-economic and other exogenous factors such as lack of antenatal consultation and Bacille Calmette-Guérin (BCG) vaccination. These different variables impacting the chances of survival of children underneath five have not been completely examined. The objective of this study is to analyse the socio-economic variables that influence the survival risk of children beneath five in Togo. METHODS: These different variables influencing the chances of survival of the data used is from the 2017 MICS6 Overview. It speaks to an arrangement of broadly agent tests of families, children matured 0-5 years, women matured 15-49 years and men matured 15-59 years. Information on pre-birth meetings and the inoculation status of children at (BCG) were collected from this overview. The Cox corresponding risks backslide illustrate is used to evaluate the connection between pre-birth visits and child survival. RESULTS: The risk of survival in children beneath 5 years is high as the age of the mother increases. This risk is 0.48 for the age between 19 and 24 years (AHR = 2.485, 95% CI 1.49-4.13). A child born to a woman with no education is at high risk of child survival (AHR = 2.96, 95% CI 092-9.36). Furthermore, the results show that women with twins have a high risk of 0.44 of the death of these children (AHR = 1.44, 95% CI 1.25-1.67). In addition, (BCG) vaccination has been related with an expanded recurrence in children, where it was found that 70.37% of vaccinated children were born to women who had experienced pre-birth meetings. CONCLUSION: Basic risk variables for child survival can offer assistance in defining policy suggestions for children's wellbeing. The results recommend they have to empower policies to improve women's proficiency, the presence of a wellbeing insurance framework is suggested to decrease the burden of care, implement a procedure for access to antenatal meetings.

Virtual car seat checks during a pandemic.

Motor vehicle collisions are one of the leading causes of death and morbidity in children and young adults in the USA, and suboptimal child restraint use is an important risk factor for severe childhood injury and death. The restrictions due to the COVID-19 pandemic have presented unique challenges to the public health community, including how to use certified child passenger safety technicians through car seat checks. This case series assessed the feasibility of performing remote car seat checks and parental satisfaction with them. It provides preliminary evidence that remote car seat checks are feasible in a real-world environment and acceptable to caregivers during times in which in-person car seat checks are not safe or accessible.

Inequities in child survival in Nigerian communities during the Sustainable Development Goal era: insights from analysis of 2016/2017 Multiple Indicator Cluster Survey.

BACKGROUND: Child survival is a major concern in Nigeria, as it contributes 13% of the global under-five mortalities. Although studies have examined the determinants of under-five mortality in Nigeria, the comparative roles of social determinants of health at the different stages of early childhood development have not been concurrently investigated. This study, therefore, aimed to identify the social determinants of age-specific childhood (0-59 months) mortalities, which are disaggregated into neonatal mortality (0-27 days), post-neonatal mortality (1-11 months) and child mortality (12-59 months), and estimate the within-and between-community variations of mortality among under-five children in Nigeria. This study provides evidence to guide stakeholders in planning for effective child survival strategies in the Nigerian communities during the Sustainable Development Goals era. METHODS: Using the 2016/2017 Nigeria Multiple Indicator Cluster Survey, we performed multilevel multinomial logistic regression analysis on data of a nationally representative sample of 29,786 (weighted = 30,960) live births delivered 5 years before the survey to 18,497 women aged 15-49 years and nested within 16,151 households and 2227 communities. RESULTS: Determinants of under-five mortality differ across the neonatal, post-neonatal and toddler/pre-school stages in Nigeria. Unexpectedly, attendance of skilled health providers during delivery was associated with an increased neonatal mortality risk, although its effect disappeared during post-neonatal and toddler/pre-school stages. Also, our study found maternal-level factors such as maternal education, contraceptive use, maternal wealth index, parity, death of previous children, and quality of perinatal care accounted for high variation (39%) in childhood mortalities across the communities. The inclusion of other compositional and contextual factors had no significant additional effect on childhood mortality risks across the communities. CONCLUSION: This study reinforces the importance of maternal-level factors in reducing childhood mortality, independent of the child, household, and community-level characteristics in the Nigerian communities. To tackle childhood mortalities in the communities, government-led strategies should prioritize implementation of community-based and community-specific interventions aimed at improving socioeconomic conditions of women. Training and continuous mentoring with adequate supervision of skilled health workers must be ensured to improve the quality of perinatal care in Nigeria.

Current Knowledge of Breastfeeding Among Health Workers in a Developing Country Setting: A Survey in Calabar, Nigeria.

Background Health workers are in a strategic position to provide correct information to mothers on breastfeeding practice. This study assessed knowledge of breastfeeding among health workers in health facilities in Calabar. Methods This was a cross-sectional descriptive study. A 45-item self-administered questionnaire was used to obtain data. Ethical clearance for the study was obtained from the Cross River State Research and Ethics Committee. Data were analyzed using SPSS version 21.0 (SPSS, Inc., Chicago, USA). A knowledge score of at least 90% was considered satisfactory. Factors associated with the level of knowledge were determined using chi-square. The p-value was set at 0.05. Result Two hundred and twenty-five healthcare professionals were surveyed, with a mean age of 37.5 ± 9.4 years, ranging from 20 to 65 years. The commonest age group was 41 to 50 years (43.1%). Females (80.9%) formed a larger proportion of participants with a female-male ratio of 4:1. The mean percentage of knowledge score was 85.1 ± 9.0%. A satisfactory level of knowledge was found in 27.1% of respondents. About one-third (33.7%) and one-fifth (21.8%) of health workers were not aware of the weight control benefit and protection against osteoporosis of breastmilk, respectively. Approximately one-fifth (22.2%) of respondents had misconceptions concerning the effects of colostrum on the prevention of neonatal jaundice. Nurses with diploma level of training had a satisfactory level of knowledge, compared with other professions (p < 0.05). Conclusion Health workers' knowledge of breastfeeding was generally good though suboptimal. Health-related professions should provide current information on the best breastfeeding practices.

Routine vitamin A supplementation and other high impact interventions in Sierra Leone.

In 2017, transition to routine vitamin A supplementation (VAS) commenced as an integrated reproductive and child health service including vaccinations, Albendazole for deworming, complementary feeding demonstrations, 'quality' family planning counselling and provision of modern contraceptives. After 10 months, a lot quality assurance sampling survey evaluated coverage of these interventions. Each of three districts was divided into five supervision areas (lots), and 19 villages were randomly selected in each lot proportional to population size. Households were randomly selected, and a questionnaire was administered to a caregiver of a child 6-11, 12-23 and 24-59 months in each village. Overall, caregivers of 855 children were interviewed, and 19 questionnaires were completed for each age group (6-11, 12-23 and 24-59 months) in each of the five lots in each district. All lots in one district passed the threshold of 80% for VAS and 75% coverage for Albendazole, and two lots failed for either VAS/Albendazole in the other two districts. Overall, weighted VAS coverage for children 6-59 months was 86.9%, and weighted Albendazole coverage for children 12-59 months was 80.9%. Most caregivers (77.2%) knew that complementary feeding should be introduced at 6 months, 44.9% were providing three or more (of six) food groups, 84.9% were aware of family planning and 37.5% were using a modern contraceptive. Integration of reproductive and child health services appears to be a suitable platform for routine VAS and Albendazole whilst improving complementary feeding practices and access to family planning.

Facilitators and barriers to child restraint use in motor vehicles: a qualitative evidence synthesis.

BACKGROUND: Road traffic collisions contribute a significant burden of mortality and morbidity to children globally. The improper or non-use of child restraints can result in children sustaining significant injuries in the event of a collision. Systematic reviews on the effectiveness of various interventions to increase the use of child restraints already exist but to the best of our knowledge, there has been no qualitative evidence syntheses on the facilitators and barriers to child restraint usage. This review aims to fill that gap. METHODS: We searched for qualitative studies, which focused on perceptions, values and experiences of children, parents/caregivers or any other relevant stakeholders on the use of restraints for children travelling in motor vehicles in PubMed, EMBASE and Global Health and screened reference lists of all included studies. We assessed the quality of included studies with the Critical Appraisal Skills Programme (CASP) checklist and used the PROGRESS Plus lens for an equity focused analysis. RESULTS: We identified a total of 335 records from searching the databases and five records from other sources. After screening, we identified 17 studies that met our inclusion criteria. All but one study (which had children as participants) focused on the perceptions, attitudes and barriers of parents or caregivers. The included studies were from three high-income (n=14) and one upper-middle income (n=3) country. In addition, although many focused exclusively on participants from culturally and linguistically diverse minorities, the issue of equity was not well addressed. Five major themes emerged from the analysis. (1) perceived risk for injuries and perceived safety benefits of child restraint usage varies in different settings and between different types of caregivers; (2) practical issues around the use of child restraints is a major barrier to its uptake as a child safety measure; (3) restraint use is considered as a mechanism to discipline children rather than as a safety device by parents and as children became older they actively seek opportunities to negotiate the non-usage of restraints; (4) adoption and enforcement of laws shape perceptions and usage in all settings and (5) perceptions and norms of child safety differ among culturally and linguistically diverse groups. CONCLUSION: The results of this systematic review should be considered when designing interventions to promote the uptake of child restraints. However, there is a need to conduct qualitative research around the facilitators and barriers to child restraint usage in low-income and middle-income countries. Furthermore, there is a need for more evidence conducted in semiurban and rural areas and to involve fathers, policy-makers, implementers and enforcement agencies in such studies.

Breastfeeding and child survival from 0 to 5 years in Côte d'Ivoire.

BACKGROUND: One of the main objectives of health policy-makers is to promote children's growth, development, and survival. The current research evaluates the impact of breastfeeding on infant survival and highlights the major socio-economic determinants of child survival from 0 to 5 years old in Côte d'Ivoire. METHODS: This study uses Probit estimation to evaluate the impact of the type of breastfeeding on the survival of children aged from 0 to 5 years old. The main socio-economic determinants of child survival were identified and analyzed. The sample of the study covers 7776 children under 5 years old drawn from the Côte d'Ivoire Demographic Health Surveys and the Multiple Indicators cluster survey of 2012. RESULTS: A child is more likely to survive when immediate exclusive breastfeeding was practiced for up to 6 months. The probability of survival increases significantly when the mother lives in a healthy environment, when she has at least a primary school education, and when she plays a leading role in caring for the children. Likewise, when she better controls the market of some breast milk supplement and she chooses the best milk formula to complete feeding for her baby, the child's chances of survival increase significantly. CONCLUSION: Health policy-makers must strengthen programs to promote exclusive breastfeeding up to 6 months through social campaigns. It should also strengthen the capacity of health workers (midwives, nurses, doctors, etc.) to better guide and provide training to mothers and young women about childbearing age to allow them to practice exclusive breastfeeding for up to 6 months. It is only after 6 months that they have to complete infant feeding by providing some semi-solid food rich in vitamins, proteins, and minerals. Taking into account the time constraint when they are engaged in economic activity, they must choose the best formula milk to supplement breastfeeding. It is also important to educate women to improve hygiene in their housing, in their neighborhood and in their community in order to promote the welfare and health of their children.

BCG scarring and improved child survival: a combined analysis of studies of BCG scarring.

Bacillus Calmette-Guérin (BCG) vaccine against tuberculosis (TB) is recommended at birth in TB-endemic areas. Currently, BCG vaccination programmes use "BCG vaccination coverage by 12 months of age" as the performance indicator. Previous studies suggest that BCG-vaccinated children, who develop a scar, have better overall survival compared with BCG-vaccinated children, who do not develop a scar. We summarized the available studies of BCG scarring and child survival. A structured literature search for studies with original data and analysis of BCG scarring and mortality were performed. Combined analyses on the effect of BCG scarring on overall mortality. We identified six studies covering seven cohorts, all from Guinea-Bissau, West Africa, with evaluation of BCG scarring amongst BCG-vaccinated children and follow-up for mortality. Determinants of BCG scarring were BCG strain, intradermal injection route, size of injection wheal, and co-administered vaccines and micronutrients. In a combined analysis, having a BCG scar vs. no BCG scar was associated with a mortality rate ratio (MRR) of 0.61 (95% CI: 0.51-0.74). The proportion with a BCG scar varied from 52 to 93%; the estimated effect of a BCG scar was not associated with the scar prevalence. The effect was strongest in the first (MRR = 0.48 (0.37-0.62)) and second (MRR = 0.63 (0.44-0.92)) year of life, and in children BCG-vaccinated in the neonatal period (MRR = 0.45 (0.36-0.55)). The effect was not explained by protection against TB. Confounding and genetic factors are unlikely to explain the strong association between BCG scarring and subsequent survival. Including "BCG scar prevalence" as a BCG vaccination programme performance indicator should be considered. The effect of revaccinating scar-negative children should be studied.

Equity dimensions of the decline in under-five mortality in Ghana: a joinpoint regression analysis.

BACKGROUND: There has been a global rise in interest and efforts to improve under-five mortality rates, especially in low- and middle-income countries. Ghana has made some progress in improving this outcome; however, the extent of such progress and its equity implications remains understudied. METHODS: This study used a joinpoint regression analysis to assess the significance of changes in trends of under-five mortality rates in Ghana between 1988 and 2017 using data from seven rounds of the Ghana Demographic and Health Survey. Annual percentage change (APC) was estimated. The APCs of different dimensions of equity (residence, administrative region, maternal education and wealth quintile) were compared by coincidence test - to determine similarity in joinpoint regression functions via 10 000 Monte Carlo resampling. RESULTS: There has been progress in reduction of under-five mortality in Ghana between 1988 and 2017 with an annual percentage change of -3.49%. Disaggregation of the trends showed that the most rapid improvement in under-five mortality rates occurred in the Upper East Region (APC = -5.0%). The closing of under-five mortality equity gaps in the study period has been uneven in the country. The gap between rural and urban rates has closed the most, followed by regional gaps (between Upper East and Ashanti Region), while the most persistent gaps remain in maternal education and wealth quintile. CONCLUSION: The findings suggest that programmatic interventions have been more successful in reducing geographic (rural-urban and by administrative region) than non-geographic (maternal education and wealth quintile) inequities in under-five mortality in Ghana. To accelerate reduction and bridge the inequities in under-five mortality, Ghana may need to pursue more social policies aimed at redistribution.

CONTEXTE: Il y a eu une augmentation mondiale de l'intérêt et des efforts pour améliorer les taux de mortalité des moins de cinq ans, en particulier dans les pays à revenu faible et intermédiaire. Le Ghana a fait quelques progrès dans l'amélioration de ce résultat; cependant, l'ampleur de ces progrès et ses implications en termes d'équité restent sous-étudiées. MÉTHODES: Cette étude a utilisé une analyse de régression à point de jonction pour évaluer l'importance des changements dans les tendances des taux de mortalité des moins de cinq ans au Ghana entre 1988 et 2017 en utilisant les données de sept cycles de l'enquête démographique et de santé du Ghana. La variation annuelle en pourcentage (VAP) a été estimée. Les VAP des différentes dimensions d'équité (résidence, région administrative, éducation de la mère et quintile de richesse) ont été comparées par test de coïncidence, pour déterminer la similarité des fonctions de régression à point de jonction via 10000 rééchantillonnage de Monte Carlo. RÉSULTATS: Des progrès ont été atteints dans la réduction de la mortalité des moins de cinq ans au Ghana entre 1988 et 2017 avec une VAP de -3,49%. La désagrégation des tendances a montré que l'amélioration la plus rapide des taux de mortalité des moins de cinq ans s'est produite dans la région du Haut-Est (VAP = -5,0%). La réduction des écarts d'équité en matière de mortalité des moins de cinq ans au cours de la période d'étude a été inégale dans le pays. L'écart entre les taux ruraux et urbains s'est le plus resserré, suivi des écarts régionaux (entre le Haut-Est et la région Ashanti), tandis que les écarts les plus persistants restent dans l'éducation des mères et le quintile de richesse. CONCLUSION: Les résultats suggèrent que les interventions programmatiques ont mieux réussi à réduire les inégalités géographiques (rurales-urbaines et par région administrative) que les inégalités non géographiques (éducation des mères et quintile de richesse) dans la mortalité des moins de cinq ans au Ghana. Pour accélérer la réduction et combler les inégalités en matière de mortalité des moins de cinq ans, le Ghana pourrait avoir besoin de poursuivre davantage de politiques sociales visant à la redistribution.