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Background: Improving the coverage of antenatal care is regarded as an important strategy to reduce the risks of maternal and child mortality in low income settings like Gambia. Nonetheless, a large number of countries in Africa, including Gambia, are struggling to attain an optimum level of healthcare utilization among pregnant women. The role of socioeconomic inequalities in maternal healthcare uptake has received little attention in Gambia. To address this evidence gap, the present study analyses nationally representative data to explore the socioeconomic inequalities in the use of maternal healthcare.Methods: Data on women aged 15-49 years (n = 5351) were extracted from the latest round of Gambia Demographic and Health Survey in 2013 for this study. The outcome measures were early and adequate antenatal visit and HIV tests during the last pregnancy. Data were analyzed using descriptive and multivariate regression methods. Socioeconomic status was assessed through the women's education, type of employment, and household wealth quintile.Results: From the total of 5351 participants included in the study, 38.7 and 78.8% of the women had early and adequate ANC visits respectively with a 65.4% HIV test coverage during ANC visits. The odds of early [OR = 1.30, 95% confidence interval (CI) =1.06, 1.59] and adequate [OR = 1.45, 95%CI = 1.15, 1.82] ANC visits were higher in the rural areas compared with urban. Women with secondary [OR = 1.24, 95%CI = 1.04, 1.48] and higher education [OR = 1.80, 95%CI = 1.20, 2.70] had higher odds of making early ANC visits. Women from richest wealth quintile households had significantly higher odds of having early [OR = 1.49, 95%CI = 1.14, 1.95] and adequate ANC visits [OR = 2.06, 95%CI = 1.48, 2.87], but not of having HIV tests. Having access to electronic media showed a positive association with adequate ANC visits [OR = 1.32, 95%CI = 1.08, 1.62] and with taking HIV test during ANC [OR = 1.48, 95%CI = 1.21, 1.80]. A fewer odds of having unintended child was associated with early ANC visit [OR = 0.70, 95%CI = 0.59, 0.84], but positively associated with taking HIV test [OR = 1.75, 95%CI = 1.42, 2.15].Conclusion: A large proportion of women in Gambia were not using antenatal care and HIV tests during pregnancy. There are important sociodemographic differences in using maternal healthcare services such as HIV testing during pregnancy. This calls for strategic direction to promote the utilization of these services. [ABSTRACT FROM AUTHOR]

Background: Income inequality and national wealth are strong determinants for health, but few studies have systematically investigated their influence on mortality across the early life-course, particularly outside the high-income world.Methods: We performed cross-sectional regression analyses of the relationship between income inequality (national Gini coefficient) and national wealth (Gross Domestic Product (GDP) averaged over previous decade), and all-cause and grouped cause national mortality rate amongst infants, 1-4, 5-9, 10-14, 15-19 and 20-24 year olds in low and middle-income countries (LMIC) in 2012. Gini models were adjusted for GDP.Results: Data were available for 103 (79%) countries. Gini was positively associated with increased all-cause and communicable disease mortality in both sexes across all age groups, after adjusting for national wealth. Gini was only positively associated with increased injury mortality amongst infants and 20-24 year olds, and increased non-communicable disease mortality amongst 20-24 year old females. The strength of these associations tended to increase during adolescence. Increasing GDP was negatively associated with all-cause, communicable and non-communicable disease mortality in males and females across all age groups. GDP was also associated with decreased injury mortality in all age groups except 15-19 year old females, and 15-24 year old males. GDP became a weaker predictor of mortality during adolescence.Conclusion: Policies to reduce income inequality, rather than prioritising economic growth at all costs, may be needed to improve adolescent mortality in low and middle-income countries, a key development priority. [ABSTRACT FROM AUTHOR]

Background: Though the socio-economic situation of the Ethiopian household is improving along with the decrease in under-five child mortality. But, under-five mortality is still one of the major problems. Identification of the risk factors change over time which mismatches with the diminishing rate of under-five mortality is important to address the problems.Methods: The survey data used for this research was taken from three different Ethiopian Demographic and Health Surveys (2000, 2005 and 2011). This data was used to identify the effect of time varying under-five mortality risk factors. The Cox proportional hazard model was adapted for the analysis.Results: The effect of respondent's current age, age at first birth and educational level on the under-five mortality rate significantly diminishes in the recent surveys. On the other hand, the effect of the number of births in the last 5 years increases more in 2011 than in the earlier two surveys. Similarly, number of household members in the house and the number of under-five children in the house demonstrated a difference through years. Regarding total children ever born, child death is more for the year 2000 followed by 2005 and 2011.Conclusion: Based on the study, our findings confirmed that under-five mortality is a serious problem in the country. The analysis displayed that the hazard of under-five mortality has a decreasing pattern in years. The result for regions showed that there was an increase in years for some of the regions. This research work gives necessary information to device improved teaching for family planning and children health care to change the child mortality circumstance in the country. Our study suggests that the impact of demographic characteristics and socio-economic factors on child mortality should account for their integral changes over time. [ABSTRACT FROM AUTHOR]

Background: Undernutrition remains the major public health concern in Ethiopia and continues as the underlying cause of child mortality. However, there is a scarcity of information on the magnitude and determinant factors of undernutrition. Therefore, this study aimed to assess the prevalence of undernutrition and associated factors among children aged 6-59 months in East Belesa District, northwest Ethiopia.Methods: A community-based cross-sectional study was conducted from April to May, 2014. A multistage stratified sampling technique was used to select 633 study participants. A structured interviewer-administered questionnaire was used to collect data. In order to identify factors associated with undernutrition (stunting and wasting) a multivariate logistic regression analysis was employed. The Adjusted Odds Ratio (AOR) with a 95 % Confidence Interval (CI) was computed to show the strength of the association. In the multivariate analysis, variables with a p-value of <0.05 were considered as statistically significant.Results: In this study, about 57.7 and 16 % of the children were stunted and wasted, respectively. The odds of stunting were higher in children born to mothers who gave their first birth before 15 years of age (AOR = 2.4; 95 % CI: 1.19, 5.09) and gave prelacteal feeding to their child (AOR = 1.83; 95 % CI: 1.28, 2.61). However, lower odds of stunting were observed among children aged 36-47 months (AOR = 0.41; 95 % CI: 0.22, 0.78) and had higher family monthly income, Et. Br. 750-1000, (AOR = 0.61; 95 % CI: 0.39, 0.92). Moreover, the odds of wasting were higher among children who received butter as prelacteal food (AOR = 2.32; 95 % CI:1.82, 5.31).Conclusion: Child undernutrition is a critical public health problem in the study area. Advanced age of children (36-47 months) and higher family monthly income were inversely associated with stunting. However, higher odds of stunting were observed among children whose mothers delivered their first child before 15 years of age, and gave their children prelacteal feeding. Thus, delaying the first pregnancy and reducing prelacteal feeding is of a paramount significance in reducing the burden of undernutrition. [ABSTRACT FROM AUTHOR]

Background: The Millennium Development Goal No 4 (MDG 4) requires countries to scale up interventions addressing malnutrition and other immediate determinants of burden of disease among children to reduce child mortality by two thirds by 2015, which is this year. Whereas globally some achievements have been registered, under-nourishment remains a significant problem in some developing countries such as Tanzania. This study set out to estimate the extent of stunting and its associated determinants to assess the progress made thus far towards achieving MDG 4 in Tanzania.Methods: A random sample of 678 households with under-five children was selected from two randomly selected wards of Kongwa district in Dodoma region, Tanzania. The WHO anthropometric calculator, which computes Z-scores using a reference population, was used to process the anthropometric measurement data taken from all the participants. Children with height for age Z-score of less than 2 were categorised as stunted and coded as 1 and the rest were coded as 0. Proportions of stunting were compared using the chi-square test to determine the association between stunting and the independent variables. Multivariate logistic regression analysis was carried out to determine the Adjusted Odds Ratio (AOR) of the independent determinants of stunting. The cut-off for significant association was set at p = 0.05. All these analyses used the STATA 12 software.Results: About half (49.7 %) of the children were stunted. This stunting was associated with belonging to households where the head of family was young (<35 years) (AOR = 0.67, 95 % CI 0.47-0.96, p = 0.031), young age of the mothers (AOR = 1.54, 95 % CI 1.06-2.24, p = 0.023), and economic variables such as owning a cellular phone (AOR = 0.66, 96 % CI 0.46-0.94, p = 0.023).Conclusions: Stunting was highly prevalent in Kongwa district despite general improvements in child nutritional status at the national level. Household characteristics and economic status were found to play a major role in child health. In this regard, disaggregated analyses are therefore important in identifying resilient areas in need of concerted efforts for the MDG 4 to be achieved nationwide. [ABSTRACT FROM AUTHOR]

Background: The risk of a child dying before reaching five years of age is highest in Sub-Saharan African countries. But Child mortality rates have shown substantial decline in Ethiopia. It is important to identify factors affecting under-five mortality. Methods: A structured additive logistic regression model which accounts the spatial correlation was adopted to estimate under-five mortality risk factors. The 2011 Ethiopian Demographic and Health Survey data was used for this study. Results: The analysis showed that the risk of under-five mortality increases as the family size approaches seven and keeps increasing. With respect to socio-economic factors, the greater the household wealth, the lower the mortality. Moreover, for older mothers, the chance of their child to dying before reaching five is diminishes. Conclusion: The model enables simultaneous modeling of possible nonlinear effects of covariates, spatial correlation and heterogeneity. Our findings are relevant because the identified risk factors can be used to provide priority areas for intervention activities by the government to combat under-five mortality in Ethiopia. [ABSTRACT FROM AUTHOR]

Background: Maternal mortality remains a tragedy and a key determinant for child survival. There is increasing evidence that the hazard ratio of demising for young children escalates after the death of their mothers, but few studies has been done in rural areas were HIV/AIDS is more prevalent. The aim of this study is to investigate the survival of children who lost their mothers soon or after their births in a rural setup with high HIV prevalence in South Africa.Methods: This study used a data set from Africa Health Research Institute in rural South Africa.The study population comprised children (0-10 years of age) from 2000 to 2014. We employed a Cox regression modelling approach to estimate greatest temporal hazard of the child after the death of their mothers, accounting for the confounding influence of wealth index of the household and HIV status of the mother.Results: We found 62,600 live births, and that 2191 children died when they were less than or equal to 10 years old. The mortality rates for < 5 and 5-9 years is 882.25 and 117.75 per 1000 live births respectively, with a maternal mortality rate of 447.3 deaths per 100,000 live births from 2000 to 2004. Child mortality risk was very high in less than 6 weeks after their mother's death (HR 3.45 [95%CI: 1.3-6.54]), and decreased drastically after 3 years following her death (HR 0.8 [0.2-6.3]). This increased risk was more pronounced among children aged less than 1 month and living in poor households.Conclusions: Children (less than 10 years) in rural households are at their highest risk of dying within 6 weeks of mother's death and this risk decreases substantially after the highly vulnerable window. This indicates that the period of mother's death does play a critical role on the survival of her children.Thus, understanding this risk and its timing in relation to a mother's death is critical to guide interventions and stress the relevance of assessing the interaction between clinical care and socio-economic programs in addressing the needs of orphans. [ABSTRACT FROM AUTHOR]

Background: Several low and middle-income countries (LMIC) use Demographic and Health Surveys (DHS) and/or Health and Demographic Surveillance System (HDSS) to monitor the health of their population. The level and trends of under-five mortality rates could be different in the HDSS sites compared to the DHS reports. In this study, we investigated the change in under-five mortality rates overtime in the HDSS sites and the corresponding DHS reports in eight countries and 13 sites.Methods: Under-five mortality rates in the HDSS sites were determined using number of under-five deaths (numerator) and live births (denominator). The trends and annualized rate of change (ARC) of under-five mortality rates in the HDSS sites and the DHS reports were compared by fitting exponential function.Results: Under-five mortality rates declined substantially in most of the sites during the last 10-15 years. Ten out of 13 (77 %) HDSS sites have consistently lower under-five mortality rates than the DHS under-five mortality rates. In the Kilifi HDSS in Kenya, under-five mortality rate declined by 65.6 % between 2003 and 2014 with ARC of 12.2 % (95 % CI: 9.4-15.0). In the same period, the DHS under-five mortality rate in the Coastal region of Kenya declined by 50.8 % with ARC of 6 % (95 % CI: 2.0-9.0). The under-five mortality rate reduction in the Mlomp (78.1 %) and Niakhar (80.8 %) HDSS sites in Senegal during 1993-2012 was significantly higher than the mortality decline observed in the DHS report during the same period. On the other hand, the Kisumu HDSS in Kenya had lower under-five mortality reduction (15.8 %) compared to the mortality reduction observed in the DHS report (27.7 %) during 2003-2008. Under-five mortality rate rose by 27 % in the Agincourt HDSS in South Africa between 1998 to 2003 that was contrary to the 18 % under-five mortality reduction in the DHS report during the same period.Conclusions: The inconsistency between HDSS and DHS approaches could have global implication on the estimation of child mortality and ethical issues on mortality inequalities. Further studies should be conducted to investigate the reasons of child mortality variation between the HDSS and the DHS approaches. [ABSTRACT FROM AUTHOR]

Background: Peru has made great improvements in reducing stunting and child mortality in the past decade, and has reached the Millennium Development Goals 1 and 4. The remaining challenges or missed opportunities for child survival needs to be identified and quantified, in order to guide the next steps to further improve child survival in Peru.Methods: We used the Lives Saved Tool (LiST) to project the mortality impact of proven interventions reaching every women and child in need, and the mortality impact of eliminating inequalities in coverage distribution between wealth quintiles and urban-rural residence.Results: Our analyses quantified the remaining missed opportunities in Peru, where prioritizing scale-up of facility-based case management for all small and sick babies will be most effective in mortality reduction, compared to other evidenced-based interventions that prevent maternal and child deaths. Eliminating coverage disparities between the poorest quintiles and the richest will reduce under-five and neonatal mortality by 22.0 and 40.6 %, while eliminating coverage disparities between those living in rural and urban areas will reduce under-five and neonatal mortality by 29.3 and 45.2 %. This projected neonatal mortality reduction achieved by eliminating coverage disparities is almost comparable to that already achieved by Peru over the past decade.Conclusions: Although Peru has made great strides in improving child survival, further improvement in child health, especially in newborn health can be achieved if there is universal and equitable coverage of proven, quality health facility-based interventions. The magnitude of reduction in mortality will be similar to what has been achieved in the past decade. Strengthening health system to identify, understand, and direct resources to the poor and rural areas will ensure that Peru achieve the Sustainable Development Goals by 2030. [ABSTRACT FROM AUTHOR]