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Background: Unintentional injuries is the leading cause of death in children aged 6–18 in China. Previous studies on the association between the guardians' educational levels and unintentional injuries in children have been inconclusive, and it remains unclear among the Chinese population. Therefore, this study aimed to identify the association between guardians' educational levels and unintentional injuries in children aged 6–18 in Shenzhen, China. Methods: This cross-sectional study enrolled 9,903 children aged 6–18 in Shenzhen in 2020 using a multistage cluster sampling method. Information on the children and guardians were collected, and unintentional injuries in the past year was examined by using two nested questions. Logistic regression analyses were used to test the association between the guardians' educational levels and unintentional injuries in children aged 6–18, and the crude odds ratios (ORs) and adjusted ORs with 95% confidence intervals (95% CI) were calculated. Results: 275 of the 9,903 children reported experiencing at least one unintentional injuries in the past year, and the weighted incidence of unintentional injuries was 6.3% (95% CI: 5.8–6.8%) in children aged 6–18 in Shenzhen, China. The incidence of unintentional injuries differed significantly in the guardians' education levels (P < 0.05). After adjustment for the children's variables, multiple binary logistic regression analysis showed that compared to children whose guardians' educational levels were low, children whose guardians' educational levels were high (adjusted OR = 0.57, 95% CI: 0.37–0.87) and medium (adjusted OR = 0.56, 95% CI: 0.39–0.81) had a lower odds of unintentional injuries. Similar results were also observed when further adjustment for both the children's and guardians' variables. Conclusion: The overall incidence of unintentional injuries in children aged 6–18 in Shenzhen was low, and it was associated with the guardians' educational levels. Children whose guardians' educational levels were low should be given special concern to prevent unintentional injuries, and it is suggested to reduce the incidence of unintentional injuries in children by improving the guardians' educational levels. [ABSTRACT FROM AUTHOR]

Background: Transport injuries (TI) remains one of leading causes of death in children in China. This study aimed to analyze the temporal trend of disease burden and associated risk factors of TI among children aged 0–14 years in China, utilizing data from 1990 to 2019. Methods: We retrieved data of disease burden and risk factors of TI among children aged 0–14 year in China from 1990 to 2019 from the Global Burden of Disease (GBD) dataset. We estimated incidence rate, death rate, and disability adjusted life years (DALYs) rate with a 95% uncertainty interval (95% UI), stratified by age, sex, and all type-road users. Trends in disease burden with annual percentage changes (APC) and average annual percent change (AAPC) were performed by Joinpoint regression model. Results: The incidence rate (AAPC = 1.18%, P < 0.001) of TI among children aged 0–14 years showed an increasing trend, whereas mortality rate (AAPC = -3.87%, P < 0.001) and DALYs rate (AAPC = -3.83%, P < 0.001) decreased annually. Notably, boys experienced a higher increase in incidence (1.30%) compared to girls (1.06%), but a faster decrease in mortality and DALYs rate (-3.90% vs. -3.82%, -3.88% vs. -3.79%, respectively) (Pall < 0.001). Declines in death rates and DALYs rates were observed across all age groups (Pall < 0.001), while remained the highest among children aged 0–4 in 2019. Among different road-type users, cyclist road injuries were identified as the primary cause of TI (182.3 cases per 100,000) while pedestrians were the group with the highest mortality (2.9 cases per 100,000) and DALYs rate (243 cases per 100,000) in 2019. Besides, alcohol use was a significant risk factors for TI, while low temperature appeared to be a protective factor. Conclusion: Future efforts must prioritize raising awareness among children and their guardians to mitigate the disease burden of TI in children. It's critical to enhance preventive interventions for boys, children aged 0–4 and vulnerable road users such as pedestrians and cyclists in future. [ABSTRACT FROM AUTHOR]

Background: In developing countries, the death probability of a child and mother is more significant than in developed countries; these inequalities in health outcomes are unfair. The present study encompasses a spatial analysis of maternal and child mortalities in Pakistan. The study aims to estimate the District Mortality Index (DMI), measure the inequality ratio and slope, and ascertain the spatial impact of numerous factors on DMI scores across Pakistani districts. Method: This study used micro-level household datasets from multiple indicator cluster surveys (MICS) to estimate the DMI. To find out how different the DMI scores were, the inequality ratio and slope were used. This study further utilized spatial autocorrelation tests to determine the magnitude and location of the spatial dependence of the clusters with high and low mortality rates. The Geographically Weighted Regression (GWR) model was also applied to examine the spatial impact of socioeconomic, environmental, health, and housing attributes on DMI. Results: The inequality ratio for DMI showed that the upper decile districts are 16 times more prone to mortalities than districts in the lower decile, and the districts of Baluchistan depicted extreme spatial heterogeneity in terms of DMI. The findings of the Local Indicator of Spatial Association (LISA) and Moran's test confirmed spatial homogeneity in all mortalities among the districts in Pakistan. The H–H clusters of maternal mortality and DMI were in Baluchistan, and the H–H clusters of child mortality were seen in Punjab. The results of GWR showed that the wealth index quintile has a significant spatial impact on DMI; however, improved sanitation, handwashing practices, and antenatal care adversely influenced DMI scores. Conclusion: The findings reveal a significant disparity in DMI and spatial relationships among all mortalities in Pakistan's districts. Additionally, socioeconomic, environmental, health, and housing variables have an impact on DMI. Notably, spatial proximity among individuals who are at risk of death occurs in areas with elevated mortality rates. Policymakers may mitigate these mortalities by focusing on vulnerable zones and implementing measures such as raising public awareness, enhancing healthcare services, and improving access to clean drinking water and sanitation facilities. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis (TB) is a leading cause of death among children living with HIV (CLHIV). Isoniazid preventive therapy (IPT) reduces the incidence of TB by 70% and mortality by 50% among CLHIV. However, in most developing countries including Tanzania, the uptake of IPT is suboptimal, below the 90% WHO-global uptake target. We assessed the factors associated with IPT uptake among CLHIV in Mwanza region, Tanzania. Methods: This was a multicenter facility-based cross-sectional study among CLHIV aged 1 to 10 years in seven districts of Mwanza region, Tanzania from 1st November 2021 to 20th January 2022. Data were collected using a structured interview-administered questionnaire including information on children and caregivers' demographics, caregivers' health related information and children's clinical information. Our outcome variable was uptake of IPT, defined as initiation on IPT either during the time of the study or within past three years before this study We conducted modified Poisson regression to assess the association between IPT uptake and selected exposures in Stata version 15.0. Results: A total of 415 CLHIV were enrolled, the median age of the children was 7 years (Interquartile range: 5–8). The uptake of IPT was 91% (n = 377). The majority of children's caregivers were HIV positive (86%, n = 387) and were aware about IPT (63.6%, n = 264). Factors associated with IPT uptake included; having an employed caregiver [Adjusted Prevalence Ratio (aPR): 1.06 95% Confidence Interval (CI): 1.00-1.13] and attending the ART clinic every month [aPR: 1.00; 95% CI: 0.87–1.00]. Conclusions: The uptake of IPT uptake among CLHIV in Mwanza, Tanzania exceeds the global WHO-target of ≥ 90%. Monthly ART clinic visits could be essential in promoting IPT uptake among CLHIV. [ABSTRACT FROM AUTHOR]

Abstract Background In developing countries, the death probability of a child and mother is more significant than in developed countries; these inequalities in health outcomes are unfair. The present study encompasses a spatial analysis of maternal and child mortalities in Pakistan. The study aims to estimate the District Mortality Index (DMI), measure the inequality ratio and slope, and ascertain the spatial impact of numerous factors on DMI scores across Pakistani districts. Method This study used micro-level household datasets from multiple indicator cluster surveys (MICS) to estimate the DMI. To find out how different the DMI scores were, the inequality ratio and slope were used. This study further utilized spatial autocorrelation tests to determine the magnitude and location of the spatial dependence of the clusters with high and low mortality rates. The Geographically Weighted Regression (GWR) model was also applied to examine the spatial impact of socioeconomic, environmental, health, and housing attributes on DMI. Results The inequality ratio for DMI showed that the upper decile districts are 16 times more prone to mortalities than districts in the lower decile, and the districts of Baluchistan depicted extreme spatial heterogeneity in terms of DMI. The findings of the Local Indicator of Spatial Association (LISA) and Moran's test confirmed spatial homogeneity in all mortalities among the districts in Pakistan. The H–H clusters of maternal mortality and DMI were in Baluchistan, and the H–H clusters of child mortality were seen in Punjab. The results of GWR showed that the wealth index quintile has a significant spatial impact on DMI; however, improved sanitation, handwashing practices, and antenatal care adversely influenced DMI scores. Conclusion The findings reveal a significant disparity in DMI and spatial relationships among all mortalities in Pakistan's districts. Additionally, socioeconomic, environmental, health, and housing variables have an impact on DMI. Notably, spatial proximity among individuals who are at risk of death occurs in areas with elevated mortality rates. Policymakers may mitigate these mortalities by focusing on vulnerable zones and implementing measures such as raising public awareness, enhancing healthcare services, and improving access to clean drinking water and sanitation facilities.

Background: The United Nations' Millennium Development Goals and Sustainable Development Goals both underscore the critical need to reduce the under-five mortality rate globally. China has made remarkable progress in decreasing the mortality rate of children under five. This study aims to examine the trends in child mortality rates from 2002 to 2022 and the causes of deaths among neonates, infants, and children under 5 years of age from 2013 to 2022 in Huangshi. Methods: The data resource was supported and provided by the Huangshi Health Commission, Huangshi Maternal and Child Health Hospital, and the Huangshi Statistics Bureau. Figures were drawn using Origin 2021. Results: The mortality rate among children under 5 years old significantly decreased, from 21.38 per 1,000 live births in 2002 to 3.53 per 1,000 live births in 2022. The infant mortality rate also saw a significant decline, to 15.06 per 1,000 live births. Among the 1,929 recorded child deaths from 2013 to 2022, the top three causes were: F2 (Disorders related to short gestation and low birth weight), accounting for 17.26% (333 deaths); I1 (Accidental drowning and submersion), for 14.83% (286 deaths); and I3 (Other accidental threats to breathing), for 12.29% (237 deaths). Of the 1,929 deaths, 1,117 were male children, representing 57.91%. The gender disparity in the Under-5 Mortality Rate (U5MR) was calculated to be 1.38 (boys to girls). The leading causes of death under the age of five shifted from F2 (Disorders related to short gestation and low birth weight) to I1 (Accidental drowning and submersion) as children aged, highlighting the need for policymakers and parents to intensify care and vigilance for children. Conclusions: Huangshi has achieved significant progress in lowering child mortality rates over the past two decades. The study calls for policymakers to enact more effective measures to further reduce the mortality rate among children under 5 years of age in Huangshi. Furthermore, it advises parents to dedicate more time and effort to supervising and nurturing their children, promoting a safer and healthier development. [ABSTRACT FROM AUTHOR]

Background: Infant mortality rates are reliable indices of the child and general population health status and health care delivery. The most critical factors affecting infant mortality are socioeconomic status and ethnicity. The aim of this study was to assess the association between socioeconomic disadvantage, ethnicity, and perinatal, neonatal, and infant mortality in Slovakia before and during the COVID-19 pandemic. Methods: The associations between socioeconomic disadvantage (educational level, long-term unemployment rate), ethnicity (the proportion of the Roma population) and mortality (perinatal, neonatal, and infant) in the period 2017–2022 were explored, using linear regression models. Results: The higher proportion of people with only elementary education and long-term unemployed, as well as the higher proportion of the Roma population, increases mortality rates. The proportion of the Roma population had the most significant impact on mortality in the selected period between 2017 and 2022, especially during the COVID-19 pandemic (2020–2022). Conclusions: Life in segregated Roma settlements is connected with the accumulation of socioeconomic disadvantage. Persistent inequities between Roma and the majority population in Slovakia exposed by mortality rates in children point to the vulnerabilities and exposures which should be adequately addressed by health and social policies. [ABSTRACT FROM AUTHOR]

Background: Globally, childhood diarrhea is a major public health concern. Despite numerous interventions that have been put in place to reduce its incidence over the years, childhood diarrhea remains a problem and is the fourth leading cause of child mortality in Ghana. This study examined the predictors of diarrhea among children under the age of five in Ghana. Methods: Data from the 2014 Ghana Demographic and Health survey, a cross-sectional survey, was used for the purpose of this study. A total of 2,547 children under the age of five were included in this study. Logistic regression analysis was performed to establish the factors associated with childhood diarrhea and ascertain explanatory variables. Results: The prevalence of diarrhea was 11.7%. Male children (13.4%) and those living in rural areas (12%), particularly in the Brong Ahafo region (17%) recorded the highest prevalence of diarrhea. Children aged 6 to 35 months of age, maternal age and education, sex of children and region of residence were the predictors of diarrhea among children under the age of five years in this study. Conclusion: To lessen the prevalence of diarrhea among children under five in Ghana, existing interventions must be evaluated in the context of the predictors identified. Based on observations deduced from this study, the Ministry of Health, Ghana Health Service and other health regulatory agencies should intensify monitoring and awareness in the various regions, particularly in the transition and savannah zones on the causes, risk factors, and methods of preventing diarrhea in children under five. Various stakeholders including government and non-governmental organizations should take into account the predictors of diarrhea identified in the design of interventions to effectively reduce morbidity and mortality associated with childhood diarrhea. [ABSTRACT FROM AUTHOR]

Background: The high under-five mortality rate (U5MR) in Africa is a significant public health concern. Previous studies have found that satellite retrieved light at night (LAN) data with long-term and global coverage can be used as a proxy for socio-economic development and urbanization. Currently, few studies on the effects of LAN on child mortality have been conducted in Africa, a region with varying levels of urbanization between countries. Objective: To quantify the correlation between risk of child mortality and LAN as an indicator of urbanization and economic development in Africa. Methods: Using data from the Demographic and Health Survey (DHS) database conducted in 15 African countries out of 46 countries from 2005 to 2013, this study estimated LAN levels for children based on their year of birth and residential addresses. This study used Cox proportional hazards models to assess the association between LAN and the risk of child mortality in Africa. Results: The mean U5MR was 95 per 1,000 livebirths among the 15 African countries during 2005–2013. After adjusting for covariates, each 10-unit increment in LAN was associated with a 5.3% reduction in the risk of U5MR. The effect estimates were more pronounced in areas with lower LAN. Conclusion: In Africa, the risk of U5MR decreased with increasing LAN, especially in areas with lower LAN. The results suggest that the development of urbanization and socio-economic conditions may be beneficial to child health, especially in regions with low LAN. The use of LAN as a proxy may offer an intriguing approach for identifying areas requiring targeted development in urbanization and socio-economic conditions. [ABSTRACT FROM AUTHOR]

Background: Nearly all countries have ratified the United Nations Convention on the Rights of the Child and, therefore, support children having access to their rights. However, only a small minority of children worldwide have access to their environmental, economic, and social rights. The most recent global effort to address these deficits came in 2015, when the United Nations General Assembly agreed to a plan for a fairer and more sustainable future by 2030 and outlined the Sustainable Development Goals (SDGs). One remediable cause is the lack of revenue in many countries, which affects all SDGs. However, illicit financial flows from low-income to high-income countries, including international tax abuse, continue unabated. Methods: Using the most recent estimates of tax abuse perpetuated by multinational companies and tax evasion through offshore wealth, and precise econometric modelling, we illustrate the potential regarding child rights (or progress towards the SDGs) if there was an increase in revenue equivalent to tax abuse in Malawi, a low-income country particularly vulnerable to climate change. The Government Revenue and Development Estimations model provides realistic estimates of government revenue changes in developmental outcomes. Using panel data on government revenue per capita, it models the impact of increased revenue on governance and SDG progress. Results: If cross-border tax abuse and tax evasion were curtailed, the equivalent increase in government revenue in one country, Malawi, would be associated with 12,000 and 20,000 people having access to basic water and sanitation respectively each year. Each year, an additional 5000 children would attend school, 150 additional children would survive, and 10 mothers would survive childbirth. Conclusions: More children would access their economic and social rights if actions were taken to close the gap in global governance regarding taxation. We discuss the responsibility of duty bearers, the need for a global body to arbitrate and monitor international tax matters, and how the Government of Malawi could take further domestic action to mitigate the gaps in global governance and protect itself against illicit financial flows, including tax abuse. [ABSTRACT FROM AUTHOR]

Background: Non-natural mortality in children and adolescents is a global public health problem that varies widely from country to country. Data on child and adolescent maltreatment are not readily available, and mortality due to violent causes is also underestimated. Methods: Injury-related mortality rates (overall and by specific causes) from 2000 to 2018 in selected European countries were analysed to observe mortality patterns in children and adolescents using data from the Eurostat database. Age-standardized mortality rates per 100,000 person-years were calculated for each country. Joinpoint regression analysis with a significance level of 0.05 and 95% confidence intervals was performed for mortality trends. Results: Children and adolescent mortality from non-natural causes decreased significantly in Europe from 10.48 around 2005 to 5.91 around 2015. The Eastern countries (Romania, Bulgaria, Poland, Slovakia, Czech Republic) had higher rates; while Spain, Denmark, Italy, and the United Kingdom had the lowest. Rates for European Country declined by 5.10% per year over the entire period. Larger downward trends were observed in Ireland, Spain and Portugal; smaller downward trends were observed for Eastern countries (Bulgaria, Czech Republic, Poland, Slovakia) and Finland. Among specific causes of death, the largest decreases were observed for accidental causes (-5.9%) and traffic accidents (-6.8%). Conclusions: Mortality among children and adolescents due to non-natural causes has decreased significantly over the past two decades. Accidental events and transport accidents recorded the greatest decline in mortality rates, although there are still some European countries where the number of deaths among children and adolescents from non-natural causes is high. Social, cultural, and health-related reasons may explain the observed differences between countries. Key Messages: • The mortality of children and adolescents due to non-natural causes has decreased significantly in the last two decades; • Substantial differences between countries were found in the trend of non-natural causes of death in children and adolescents; • Accidental events and transport accidents showed the greatest decrease in mortality; • In some European countries, there is still a high number of deaths in children and adolescents that are due to non-natural causes; [ABSTRACT FROM AUTHOR]

Abstract Background Child mortality is a major challenge to public health in Pakistan and other developing countries. Reduction of the child mortality rate would improve public health and enhance human well-being and prosperity. This study recognizes the spatial clusters of child mortality across districts of Pakistan and identifies the direct and spatial spillover effects of determinants on the Child Mortality Rate (CMR). Method Data of the multiple indicators cluster survey (MICS) conducted by the United Nations International Children’s Emergency Fund (UNICEF) was used to study the CMR. We used spatial univariate autocorrelation to test the spatial dependence between contiguous districts concerning CMR. We also applied the Spatial Durbin Model (SDM) to measure the spatial spillover effects of factors on CMR. Results The study results showed 31% significant spatial association across the districts and identified a cluster of hot spots characterized by the high-high CMR in the districts of Punjab province. The empirical analysis of the SDM confirmed that the direct and spatial spillover effect of the poorest wealth quintile and MPI vulnerability on CMR is positive whereas access to postnatal care to the newly born child and improved drinking water has negatively (directly and indirectly) determined the CMR in Pakistan. Conclusion The instant results concluded that spatial dependence and significant spatial spillover effects concerning CMR exist across districts. Prioritization of the hot spot districts characterized by higher CMR can significantly reduce the CMR with improvement in financial statuses of households from the poorest quintile and MPI vulnerability as well as improvement in accessibility to postnatal care services and safe drinking water.

Abstract Background Child death rates are often regarded as reliable indicators for overall welfare of a country since they give insight of health accessibility and development. For planning and controlling purposes, it is important to understand which ages are at higher risks of experiencing child death as well as determinants thereof. Methods We used the Sierra Leone DHS 2019 data which was collected using two stage sampling methods. Data collection involved interviewing women aged from 15–49 to obtain information about children they had in the past up to 2019. Age at death of child was modelled using discrete-time survival analysis with a logit link at the same time applying survey weights. The analysis also sought to estimate the determinants of child death (under-five mortality). The baseline hazard was modelled with a polynomial function. Results Results showed that children from rural areas had significantly lower odds of dying compared with those from urban areas (odds ratio (OR) = 0.861, p-value = 0.0003). Children of mothers who were currently using contraceptives, and those whose mothers had been using since their last birth were at higher odds of child death compared to children whose mothers had never used contraceptives before (currently using: OR = 1.118, p-value = = 40: OR = 2.895, p-value =

Abstract Background Understanding the impact of national public expenditure and its allocation on child mortality may help governments move towards target 3.2 proposed in the 2030 Agenda. The objective of this study was to estimate the impacts of governmental expenditures, total, on health, and on other sectors, on neonatal mortality and mortality of children aged between 28 days and five years. Methods This study has an ecological design with a population of 147 countries, with data between 2012 and 2019. Two steps were used: first, the Generalized Propensity Score of public spending was calculated; afterward, the Generalized Propensity Score was used to estimate the expenditures’ association with mortality rates. The primary outcomes were neonatal mortality rates (NeoRt) and mortality rates in children between 28 days and 5 years (NeoU5Rt). Results The 1% variation in Int$ Purchasing Power Parity (Int$ PPP) per capita in total public expenditures, expenditure in health, and in other sectors were associated with a variation of -0.635 (95% CI -1.176, -0.095), -2.17 (95% CI -3.051, -1.289) -0.632 (95% CI -1.169, -0.095) in NeoRt, respectively The same variation in public expenditures in sectors other than health, was associates with a variation of -1.772 (95% CI -6.219, -1.459) on NeoU5Rt. The results regarding the impact of total and health public spending on NeoU5Rt were not consistent. Conclusion Public investments impact mortality in children under 5 years of age. Likely, the allocation of expenditures between the health sector and the other social sectors will have different impacts on mortality between the NeoRt and the NeoU5Rt.

Background: Child mortality is a major challenge to public health in Pakistan and other developing countries. Reduction of the child mortality rate would improve public health and enhance human well-being and prosperity. This study recognizes the spatial clusters of child mortality across districts of Pakistan and identifies the direct and spatial spillover effects of determinants on the Child Mortality Rate (CMR). Method: Data of the multiple indicators cluster survey (MICS) conducted by the United Nations International Children's Emergency Fund (UNICEF) was used to study the CMR. We used spatial univariate autocorrelation to test the spatial dependence between contiguous districts concerning CMR. We also applied the Spatial Durbin Model (SDM) to measure the spatial spillover effects of factors on CMR. Results: The study results showed 31% significant spatial association across the districts and identified a cluster of hot spots characterized by the high-high CMR in the districts of Punjab province. The empirical analysis of the SDM confirmed that the direct and spatial spillover effect of the poorest wealth quintile and MPI vulnerability on CMR is positive whereas access to postnatal care to the newly born child and improved drinking water has negatively (directly and indirectly) determined the CMR in Pakistan. Conclusion: The instant results concluded that spatial dependence and significant spatial spillover effects concerning CMR exist across districts. Prioritization of the hot spot districts characterized by higher CMR can significantly reduce the CMR with improvement in financial statuses of households from the poorest quintile and MPI vulnerability as well as improvement in accessibility to postnatal care services and safe drinking water. [ABSTRACT FROM AUTHOR]

Background: Child death rates are often regarded as reliable indicators for overall welfare of a country since they give insight of health accessibility and development. For planning and controlling purposes, it is important to understand which ages are at higher risks of experiencing child death as well as determinants thereof. Methods: We used the Sierra Leone DHS 2019 data which was collected using two stage sampling methods. Data collection involved interviewing women aged from 15–49 to obtain information about children they had in the past up to 2019. Age at death of child was modelled using discrete-time survival analysis with a logit link at the same time applying survey weights. The analysis also sought to estimate the determinants of child death (under-five mortality). The baseline hazard was modelled with a polynomial function. Results: Results showed that children from rural areas had significantly lower odds of dying compared with those from urban areas (odds ratio (OR) = 0.861, p-value = 0.0003). Children of mothers who were currently using contraceptives, and those whose mothers had been using since their last birth were at higher odds of child death compared to children whose mothers had never used contraceptives before (currently using: OR = 1.118, p-value = <.0001; used since last birth: OR = 1.372, p-value = <.0001). Children with no health insurance had significantly higher odds of death than those with health insurance (OR = 1.036, p-value = <.0001). Children of women who were married, and of women who were formerly married were at significantly higher odds of experiencing child death than children of women who had never been in union (married: OR = 1.207, p-value = 0.0003; formerly married: OR = 1.308, p-value = 0.0009 compared to those that have never been married). Increase in the age group of mothers increases the odds of their children experiencing child death compared to mothers in their teenage years (20-29: OR = 1.943, p-value = <.0001, 30-39: OR = 2.397, p-value = <.0001 and > = 40: OR = 2.895, p-value = <.0001 compared to mothers in their 15-19 years). Conclusion: The study provides evidence that residing in urban areas, marital union of the mother, children having no health insurance, use of contraceptives by mother, older ages of the mother and no health insurance significantly increase the odds of child death. This points out to a possible need for improved health infrastructure to be made available to citizens in all places of delivery and more awareness on pregnancy related complications. [ABSTRACT FROM AUTHOR]

Background: Childhood tuberculosis (TB) was poorly studied in Ethiopia. This study aimed to describe the epidemiology of childhood TB and identify predictors of death among children on TB treatment. Methods: This is a retrospective cohort study of children aged 16 and younger who were treated for TB between 2014 and 2022. Data were extracted from TB registers of 32 healthcare facilities in central Ethiopia. Phone interview was also conducted to measure variables without a space and not recorded in the registers. Frequency tables and a graph were used to describe the epidemiology of childhood TB. To perform survival analysis, we used a Cox proportional hazards model, which was then challenged with an extended Cox model. Results: We enrolled 640 children with TB, 80 (12.5%) of whom were under the age of two. Five hundred and fifty-seven (87.0%) of the enrolled children had not had known household TB contact. Thirty-six (5.6%) children died while being treated for TB. Nine (25%) of those who died were under the age of two. HIV infection (aHR = 4.2; 95% CI = 1.9–9.3), under nutrition (aHR = 4.2; 95% CI = 2.2-10.48), being under 10 years old (aHR = 4.1; 95% CI = 1.7–9.7), and relapsed TB (aHR = 3.7; 95% CI = 1.1–13.1) were all independent predictors of death. Children who were found to be still undernourished two months after starting TB treatment also had a higher risk of death (aHR = 5.64, 95% CI = 2.42–13.14) than normally nourished children. Conclusions: The majority of children had no known pulmonary TB household contact implying that they contracted TB from the community. The death rate among children on TB treatment was unacceptably high, with children under the age of two being disproportionately impacted. HIV infection, baseline as well as persistent under nutrition, age < 10 years, and relapsed TB all increased the risk of death in children undergoing TB treatment. [ABSTRACT FROM AUTHOR]

Abstract Background There is still a gap in knowledge of the impact that child marriage could have on the mortality and morbidity of children in Afghanistan. This study used the data from the latest Afghanistan demographic health survey conducted in 2015 (ADHS) to address this gap and advance the current knowledge. Methods A secondary analysis of the 2015 ADHS, including the births in the past 5 years to ever-married women aged 15–24 years old, was carried out. Logistic regression analyses were employed to examine the association of child marriage (

Background: Poisoning of children after exposure to pesticides is a major public health concern, particularly in countries with poorer urban populations, such as South Africa. This may stem from the illegal distribution and domestic use of street pesticides, which are highly hazardous agricultural pesticides. The aim of this study was to profile paediatric deaths due to acute pesticide poisoning in the west-metropole of Cape Town, South Africa; to identify whether the active ingredients were highly hazardous pesticides according to the FAO and WHO; and to inform policy and public health interventions to prevent future exposures and mortality. Methods: A retrospective and descriptive analysis of forensic post-mortem records (2010 to 2019) was conducted to identify cases of paediatric deaths (< 18 years old) in the west metropole of Cape Town, involving pesticide poisoning admitted to the Salt River mortuary (one out of 16 mortuaries in the Western Cape province). Demographic, circumstantial, autopsy, and toxicological information was captured. Descriptive statistics, together with chi-square tests, Fisher's probability tests, and Mann–Whitney U tests were used to analyse the data. Results: In total, 54 paediatric pesticide deaths were identified, including 22 (40.7%) males and 32 (59.3%) females, out of 5,181 paediatric unnatural deaths admitted over the 10-year period. The median age of the decedents was 8.3 years (range: 1 day to 17.9 years), with the majority under five years (42.6%) or between 15 and 18 years old (40.7%). All incidents occurred in peri-urban areas of Cape Town, with most individuals being admitted to hospital (88.9%) for a median survival time of 4.8 h. Toxicological analysis was requested in 50 cases (92.6%) with the organophosphate pesticides terbufos (n = 29), methamidophos (n = 2) and diazinon (n = 2) detected most frequently. Adolescent (15–18 years) suicides (29.6%) and accidental child deaths (< 4 years) (18.5%) were common. Conclusions: Terbufos and methamidophos are highly hazardous pesticide (HHP) active ingredients registered in South Africa for agricultural uses, yet commonly sold as street pesticides for domestic use in lower socioeconomic areas. Reducing access and availability of toxic pesticides, especially through the illegal selling of street pesticides, and providing low toxic alternatives to poorer communities, may support mortality reduction initiatives. Mortality and toxicology data provide important, often overlooked, surveillance tools for informing policy and public health interventions to reduce toxic pesticide harm in local communities. [ABSTRACT FROM AUTHOR]

Background: Understanding the impact of national public expenditure and its allocation on child mortality may help governments move towards target 3.2 proposed in the 2030 Agenda. The objective of this study was to estimate the impacts of governmental expenditures, total, on health, and on other sectors, on neonatal mortality and mortality of children aged between 28 days and five years. Methods: This study has an ecological design with a population of 147 countries, with data between 2012 and 2019. Two steps were used: first, the Generalized Propensity Score of public spending was calculated; afterward, the Generalized Propensity Score was used to estimate the expenditures' association with mortality rates. The primary outcomes were neonatal mortality rates (NeoRt) and mortality rates in children between 28 days and 5 years (NeoU5Rt). Results: The 1% variation in Int$ Purchasing Power Parity (Int$ PPP) per capita in total public expenditures, expenditure in health, and in other sectors were associated with a variation of -0.635 (95% CI -1.176, -0.095), -2.17 (95% CI -3.051, -1.289) -0.632 (95% CI -1.169, -0.095) in NeoRt, respectively The same variation in public expenditures in sectors other than health, was associates with a variation of -1.772 (95% CI -6.219, -1.459) on NeoU5Rt. The results regarding the impact of total and health public spending on NeoU5Rt were not consistent. Conclusion: Public investments impact mortality in children under 5 years of age. Likely, the allocation of expenditures between the health sector and the other social sectors will have different impacts on mortality between the NeoRt and the NeoU5Rt. [ABSTRACT FROM AUTHOR]

Background: In this study, we estimated the trend of unintentional injury mortality among children aged under-five years in China during 2010–2020. Methods: Data were obtained from China's Under 5 Child Mortality Surveillance System (U5CMSS). The total unintentional injury mortality and all specific-causes unintentional injury mortality was calculated, annual numbers of deaths and live births were adjusted by a 3-year moving average under-reporting rate. The Poisson regression model and the Cochran-Mantel-Haenszel method were used to calculate the average annual decline rate (AADR) and the adjusted relative risk (aRR) of the unintentional injury mortality. Results: In 2010–2020, a total of 7,925 unintentional injury-related deaths were reported in U5CMSS, accounting for 18.7% of all reported deaths. The overall proportion of unintentional injury-related deaths to total under-five children deaths has increased from 15.2% to 2010 to 23.8% in 2020 (χ2 = 227.0, p < 0.001), the unintentional injury mortality significantly decreased from 249.3 deaths per 100,000 live births in 2010 to 178.8 deaths per 100,000 live births in 2020, with an AADR 3.7% (95%CI 3.1–4.4). The unintentional injury mortality rate decreased from 2010 to 2020 in both urban (from 68.1 to 59.7 per 100,000 live births) and rural (from 323.1 to 230.0 per 100,000 live births) areas (urban: χ2 = 3.1, p < 0.08; rural: χ2 = 113.5, p < 0.001). The annual rates of decline in rural areas and urban areas were 4.2% (95%CI 3.4–4.9) and 1.5% (95%CI 0.1–3.3), respectively. The leading causes of unintentional injury mortality were suffocation (2,611, 32.9%), drowning (2,398, 30.3%), and traffic injury (1,428, 12.8%) in 2010–2020. The cause-specific of unintentional injury mortality rates decreased with varying AADRs in 2010–2020, except for traffic injury. The composition of unintentional injury-related deaths also varied by age group. Suffocation was the leading cause in infants, drowning and traffic injury were the leading causes in children aged 1–4 years. Suffocation and poisoning has high incidence in October to March and drowning has high in June to August. Conclusion: The unintentional injury mortality rate of children aged under-five years decreased significantly from 2010 to 2020 in China, but great inequity exists in unintentional injury mortality in urban and rural areas. Unintentional injuries are still an important public health problem affecting the health of Chinese children. Effective strategies should be strengthened to reduce unintentional injury in children and these policies and programmes should be targeted to more specific populations, such as rural areas and males. [ABSTRACT FROM AUTHOR]

Background: Despite anaemia is the leading cause of child morbidity and mortality in Africa including Ethiopia, there is inadequate evidence on modelling anaemia related factors among under five years old children in Ethiopia. Therefore, this study is aimed to assess factors that affect the anaemia status among under five years old children and estimate the proportion of overall child-level variation in anaemia status that is attributable to various factors in three regions of Ethiopia, namely Amhara, Oromiya and Southern Nation Nationalities People (SNNP). Methods: This is a cross-sectional study, and the data was extracted from the 2011 Ethiopia National Malaria Indicator Survey which is a national representative survey in the country. A sample of 4,356 under five years old children were obtained from three regions. Based on child hemoglobin level, anaemia status was classified as non-anaemia (>11.0g/dL), mild anaemia (8.0-11.0g/dL), moderate anaemia (5.0-8.0g/dL) and severe anaemia (<5.0g/dL). Various multilevel proportional odds models with random Kebele effects were adopted taking into account the survey design weights. All the models were fitted with the PROC GLIMMIX in SAS. The Brant test for parallel lines assumption was done using the brant() function from brant package in R environment. Results: The prevalence of anaemia status of under five years children varies among the three study regions, where the prevalence of severe child anaemia status was higher in Oromiya region as compared to Amhara and SNNP regions. The results of this study indicate that age (OR = 0.686; 95% CI: 0.632, 0.743), malaria RDT positive (OR = 4.578; 95% 2.804, 7.473), household had used mosquito nets while sleeping (OR = 0.793; 95%: 0.651, 0.967), household wealth status and median altitude (OR = 0.999; 95%: 0.9987, 0.9993), were significantly related to the prevalence of child anaemia infection. The percentage of Kebele-level variance explained by the region and median altitude, and child / household (Level 1) characteristics was 32.1 %. Hence, large part of the Kebele-level variance (67.9%) remain unexplained. Conclusions: The weighted multilevel proportional odds with random Kebele effects model used in this paper identified four child/household and one Kebele level risk factors of anaemia infection. Therefore, the public health policy makers should focus to those significant factors. The results also show regional variation in child anaemia prevalence, thus special attention should be given to those children living in regions with high anaemia prevalence. [ABSTRACT FROM AUTHOR]

This study examines the effects of long-run civil wars on healthcare, which is an important component of human capital development and their causality nexus in Afghanistan using the MVAR (modified vector autoregressive) approach and the Granger non-causality model covering data period 2002Q3-2020Q4. The primary results support a significant long-run relationship between variables, while the results of the MVAR model indicate the per capita cost of war, per capita GDP, and age dependency ratio have significantly positive impacts on per capita health expenditures, whereas child mortality rate and crude death rate have negative impacts. The results of the Granger non-causality approach demonstrate that there is a statistically significant bidirectional causality nexus between per capita health expenditure, per capita cost of war, per capita GDP, child mortality rate, crude death rate, and age dependency ratio, while it also supports the existence of strong and significant interconnectivity and multidimensionality between per capita cost of war and per capita health expenditure, with a significantly strong feedback response from the control variables. Important policy implications sourced from the key findings are also discussed. [ABSTRACT FROM AUTHOR]

Background: There is still a gap in knowledge of the impact that child marriage could have on the mortality and morbidity of children in Afghanistan. This study used the data from the latest Afghanistan demographic health survey conducted in 2015 (ADHS) to address this gap and advance the current knowledge. Methods: A secondary analysis of the 2015 ADHS, including the births in the past 5 years to ever-married women aged 15–24 years old, was carried out. Logistic regression analyses were employed to examine the association of child marriage (< 18y) with morbidities (diarrhea, acute respiratory infection, and fever in the last 2 weeks), mortality (neonatal, infant, child), and size at birth among the children under 5 born to women aged 15–24 years, before and after adjusting for the effect of sociodemographic and structural inequalities. Results: Approximately two-thirds of births in the past 5 years belong to 15–24 years old mothers who married at ages < 18. The majority of them were born to mothers residing in rural areas (75.67%) with no education (51.68%) from poor households (39.39%). As compared to the births to women married at ages ≥ 18, there was a significantly higher likelihood of neonatal mortality among births to women married at ages < 18 (crude OR = 2.30, 95% CI: 1.52–3.49 & adjusted OR = 1.94, 95% CI: 1.25–3.01) and higher infant mortality among the births to the women married at ages ≤ 14y (crude OR = 1.94, 95% CI: 1.06–3.53). However, it disappeared for neonatal mortality after adjustment for adequacy of antenatal care (ANC) and infant mortality after adjustment for sociodemographic inequalities. Conclusion: Although the births to women married as a child (< 18) were more likely to die at an early age, this association disappeared after adjustment for the adequacy of ANC. Given the unavoidable practice of child marriage in Afghanistan, this finding emphasizes the importance of providing adequate ANC for young brides to prevent child mortality. In addition, strong global advocacy is required to empower and support young Afghan women in negotiating their reproductive and maternity rights with their partners by reducing social and gender-based inequalities. [ABSTRACT FROM AUTHOR]

Abstract Background Malnutrition among children under five years of age is a major public health issue in many low and middle-income constrained countries. According to WHO, 5.3 million under-five children die every year and about 45% of these deaths are linked to malnutrition. While it is clear that poverty and lack of food are important factors in children’s malnutrition, less is known about the ways in which local conceptions of malnutrition affect parents’ treatment choices. In Ethiopia, child malnutrition is a severe public health problem and a common cause of child death, and this paper explores the local views of malnutrition and how these shape people’s health-seeking behaviour. Methods The study was conducted in eastern Ethiopia from December 2017 to January 2019, conducting interviews and focus group discussions to explore different views and treatment options malnutrition. The study used grounded theory because it allows new and unexpected themes to arise from the data. Researchers’ assumptions on local terminologies of child malnutrition are also controlled as a principle of ground theory. Results Child malnutrition was not only perceived to be related to lack of food but was understood in a wider local conceptualization of health and illness. Parents often relied on healers because they are long-standing members of the community, possess indigenous knowledge, and cost less than other options. Because health professionals and the community perceive and speak of health very differently, people often do not seek support from health services. The misalignments between how health professionals and healers diagnose and treat malnourished children have implications on the possibilities to implement change to reduce malnutrition. Conclusions Through an exploration of people’s own terminology and understandings of what a malnourished child is, as well as the underlying reasons for their illness, this paper explores how people understand malnutrition symptoms and why many tend to rely on healers rather than seeking care from health centres.

Background: Despite the civil registration and vital statistics (CRVS) system in Nepal operating for several decades, it has not been used to produce routine mortality statistics. Instead, mortality statistics rely on irregular surveys and censuses that primarily focus on child mortality. To fill this knowledge gap, this study estimates levels and subnational differentials in mortality across all ages in Nepal, primarily using CRVS data adjusted for incompleteness.Methods: We analyzed death registration data (offline or paper-based) and CRVS survey reported death data, estimating the true crude death rate (CDR) and number of deaths by sex and year for each province and ecological belt. The estimated true number of deaths for 2017 was used with an extension of the empirical completeness method to estimate the adult mortality (45q15) and life expectancy at birth by sex and subnational level. Plausibility of subnational mortality estimates was assessed against poverty head count rates.Results: Adult mortality in Nepal for 2017 is estimated to be 159 per 1000 for males and 116 for females, while life expectancy was estimated as 69.7 years for males and 73.9 years for females. Subnationally, male adult mortality ranges from 129 per 1000 in Madhesh to 224 in Karnali and female adult mortality from 89 per 1000 in Province 1 to 159 in Sudurpashchim. Similarly, male life expectancy is between 64.9 years in Karnali and 71.8 years in Madhesh and female male life expectancy between 69.6 years in Sudurpashchim and 77.0 years in Province 1. Mountain ecological belt and Sudurpashchim and Karnali provinces have high mortality and high poverty levels, whereas Terai and Hill ecological belts and Province 1, Madhesh, and Bagmati and Gandaki provinces have low mortality and poverty levels.Conclusions: This is the first use of CRVS system data in Nepal to estimate national and subnational mortality levels and differentials. The national results are plausible when compared with Global Burden of Disease and United Nations World Population Prospects estimates. Understanding of the reasons for inequalities in mortality in Nepal should focus on improving cause of death data and further strengthening CRVS data. [ABSTRACT FROM AUTHOR]

Introduction: Diarrhea is a leading cause of child morbidity and mortality worldwide and is linked to early childhood stunting. Food contamination from improper preparation and hygiene practices is an important transmission pathway for exposure to enteric pathogens. Understanding the barriers and facilitators to hygienic food preparation can inform interventions to improve food hygiene. We explored food preparation and hygiene determinants including food-related handwashing habits, meal preparation, cooking practices, and food storage among caregivers of children under age two in Western Kenya.Methods: We used the Capabilities, Opportunities, and Motivations model for Behavior Change (COM-B) framework in tool development and analysis. We conducted 24 focus group discussions with mothers (N = 12), fathers (N = 6), and grandmothers (N = 6); 29 key informant interviews with community stakeholders including implementing partners and religious and community leaders; and 24 household observations. We mapped the qualitative and observational data onto the COM-B framework to understand caregivers' facilitators and barriers to food preparation and hygiene practices.Results: Facilitators and barriers to food hygiene and preparation practices were found across the COM-B domains. Caregivers had the capability to wash their hands at critical times; wash, cook, and cover food; and clean and dry utensils. Barriers to food hygiene and preparation practices included lack of psychological capability, for instance, caregivers' lack of knowledge of critical times for handwashing, lack of perceived importance of washing some foods before eating, and not knowing the risks of storing food for more than four hours without refrigerating and reheating. Other barriers were opportunity-related, including lack of resources (soap, water, firewood) and an enabling environment (monetary decision-making power, social support). Competing priorities, socio-cultural norms, religion, and time constraints due to work hindered the practice of optimal food hygiene and preparation behaviors.Conclusion: Food hygiene is an underexplored, but potentially critical, behavior to mitigate fecal pathogen exposure for young children. Our study revealed several knowledge and opportunity barriers that could be integrated into interventions to enhance food hygiene. [ABSTRACT FROM AUTHOR]

Abstract Background Machine learning (ML) algorithms have been successfully employed for prediction of outcomes in clinical research. In this study, we have explored the application of ML-based algorithms to predict cause of death (CoD) from verbal autopsy records available through the Million Death Study (MDS). Methods From MDS, 18826 unique childhood deaths at ages 1–59 months during the time period 2004–13 were selected for generating the prediction models of which over 70% of deaths were caused by six infectious diseases (pneumonia, diarrhoeal diseases, malaria, fever of unknown origin, meningitis/encephalitis, and measles). Six popular ML-based algorithms such as support vector machine, gradient boosting modeling, C5.0, artificial neural network, k-nearest neighbor, classification and regression tree were used for building the CoD prediction models. Results SVM algorithm was the best performer with a prediction accuracy of over 0.8. The highest accuracy was found for diarrhoeal diseases (accuracy = 0.97) and the lowest was for meningitis/encephalitis (accuracy = 0.80). The top signs/symptoms for classification of these CoDs were also extracted for each of the diseases. A combination of signs/symptoms presented by the deceased individual can effectively lead to the CoD diagnosis. Conclusions Overall, this study affirms that verbal autopsy tools are efficient in CoD diagnosis and that automated classification parameters captured through ML could be added to verbal autopsies to improve classification of causes of death.

Abstract Introduction Malaria accounts for more than one-tenth of sub-Saharan Africa’s 2.8 million annual childhood deaths, and remains a leading cause of post-neonatal child mortality in Uganda. Despite increased community-based treatment in Uganda, children continue to die because services fail to reach those most at risk. This study explores the influence of two key equity factors, socioeconomic position and rurality, on whether children with fever in eastern Uganda receive timely access to appropriate treatment for suspected malaria. Methods This was a cross-sectional study in which data were collected from 1094 caregivers of children aged 6–59 months on: illness and care-seeking during the previous two weeks, treatment received, and treatment dosing schedule. Additional data on rurality and household socioeconomic position were extracted from the Iganga-Mayuge Health and Demographic Surveillance Site (HDSS) database. A child was considered to have received prompt and appropriate care for symptoms of malaria if they received the recommended drug in the recommended dosing schedule on the day of symptom onset or the next day. Unadjusted and adjusted logistic regression models were developed to explore associations of the two equity factors with the outcome. The STROBE checklist for observational studies guided reporting. Results Seventy-four percent of children had symptoms of illness in the preceding two weeks, of which fever was the most common. Children from rural households were statistically more likely to receive prompt and appropriate treatment with artemisinin-combination therapy than their semi-urban counterparts (OR 2.32, CI 1.17–4.59, p = 0.016). This association remained significant following application of an adjusted regression model that included the age of the child, caregiver relationship, and household wealth index (OR 2.4, p = 0.036). Wealth index in its own right did not exert a significant effect for children with reported fever (OR for wealthiest quintile = 1.02, CI 0.48–2.15, p = 0.958). Conclusions The findings from this study help to identify the role and importance of two key equity determinants on care seeking and treatment receipt for fever in children. Whilst results should be interpreted within the limitations of data and context, further studies have the potential to assist policy makers to target inequitable social and spatial variations in health outcomes as a key strategy in ending preventable child morbidity and mortality.

Background: Human Immunodeficiency Virus (HIV) continues to be the major cause of childhood deaths, particularly in the sub-Saharan African region. In Ethiopia, though several primary studies have been conducted on the incidence of HIV-related child mortality, the pooled incidence density mortality rate among HIV-positive children is unknown. Therefore, this systematic review and meta-analysis aimed to estimate the pooled incidence density mortality rate among HIV-positive children and identify its associated factors in Ethiopia., Methods: We browsed PubMed, HINARI, Science Direct, Google Scholar, African Journals Online, and cross-references using different search terms to identify articles. Quality appraisal was done using the Joanna Briggs Institute checklist. Meta-package was used to estimate the pooled incidence of mortality and hazard ratio (HR) of predictors. Heterogeneity was tested using the I-square statistics. Publication bias was tested using a funnel plot visual inspection and Egger's test. Data was presented using forest plots and tables. The random effect model was used to compute the pooled estimate., Results: The overall pooled incidence density mortality rate among HIV-positive children was 2.52 (95% CI: 1.82, 3.47) per 100 child years. Advanced HIV disease (hazard ratio (HR): 3.45, 95% CI (Confidence Interval): 2.64, 4.51), tuberculosis co-infection (HR: 3.19, 95% CI: 2.08, 4.88), stunting (3.22, 95% CI: 2.46, 4.22), underweight (HR: 2.71, 95% CI: 1.72, 4.26), wasting (HR: 4.14, 95% CI: 2.27, 7.58), didn't receive Isoniazid preventive therapy (HR: 3.33, 95% CI: 2.22, 4.99), anemia (HR: 3.03, 95% CI: 2.52, 3.64), fair or poor antiretroviral therapy adherence (HR: 4.14, 95% CI: 3.28, 5.28) and didn't receive cotrimoxazole preventive therapy (HR: 3.82, 95% CI: 2.49, 5.86) were factors associated with a higher hazard of HIV related child mortality., Conclusions: The overall pooled incidence density mortality rate among HIV-positive children was high in Ethiopia as compared to the national strategy target. Therefore, counseling on antiretroviral therapy adherence should be strengthened. Regular monitoring of hemoglobin levels and assessment of nutritional status should be done for all children living with HIV. Moreover, healthcare professionals should follow the national HIV treatment guidelines and provide cotrimoxazole preventive therapy and Isoniazid preventive therapy up on the guidelines for children living with HIV., Registration: Registered in PROSPERO with ID: CRD42023486902., (© 2024. The Author(s).)

Abstract Background Half of global child deaths occur in sub-Saharan Africa. Understanding child mortality patterns and risk factors will help inform interventions to reduce this heavy toll. The Nanoro Health and Demographic Surveillance System (HDSS), Burkina Faso was described previously, but patterns and potential drivers of heterogeneity in child mortality in the district had not been studied. Similar studies in other districts indicated proximity to health facilities as a risk factor, usually without distinction between facility types. Methods Using Nanoro HDSS data from 2009 to 2013, we estimated the association between under-5 mortality and proximity to inpatient and outpatient health facilities, seasonality of death, age group, and standard demographic risk factors. Results Living in homes 40–60 min and > 60 min travel time from an inpatient facility was associated with 1.52 (95% CI: 1.13–2.06) and 1.74 (95% CI: 1.27–2.40) greater hazard of under-5 mortality, respectively, than living in homes

Background: Malnutrition among children under five years of age is a major public health issue in many low and middle-income constrained countries. According to WHO, 5.3 million under-five children die every year and about 45% of these deaths are linked to malnutrition. While it is clear that poverty and lack of food are important factors in children's malnutrition, less is known about the ways in which local conceptions of malnutrition affect parents' treatment choices. In Ethiopia, child malnutrition is a severe public health problem and a common cause of child death, and this paper explores the local views of malnutrition and how these shape people's health-seeking behaviour.Methods: The study was conducted in eastern Ethiopia from December 2017 to January 2019, conducting interviews and focus group discussions to explore different views and treatment options malnutrition. The study used grounded theory because it allows new and unexpected themes to arise from the data. Researchers' assumptions on local terminologies of child malnutrition are also controlled as a principle of ground theory.Results: Child malnutrition was not only perceived to be related to lack of food but was understood in a wider local conceptualization of health and illness. Parents often relied on healers because they are long-standing members of the community, possess indigenous knowledge, and cost less than other options. Because health professionals and the community perceive and speak of health very differently, people often do not seek support from health services. The misalignments between how health professionals and healers diagnose and treat malnourished children have implications on the possibilities to implement change to reduce malnutrition.Conclusions: Through an exploration of people's own terminology and understandings of what a malnourished child is, as well as the underlying reasons for their illness, this paper explores how people understand malnutrition symptoms and why many tend to rely on healers rather than seeking care from health centres. [ABSTRACT FROM AUTHOR]

Background: Suicide is one of the leading causes of death in children and youth. Using a sample of fatal suicides among school-aged students in Hong Kong, this study aimed to demonstrate how the classification of children and adolescent suicides into distinct subgroups using cluster analysis can alert us to the heterogeneous nature of the student suicide population and increase our understanding of multidimensional underlying causes.  METHODS: Deaths by suicide of Hong Kong primary and secondary school students occurring between 2013-16 were identified. Reports were acquired from the Coroner's Court, Police Force, and Education Bureau in Hong Kong. Information about students' sociodemographic characteristics, suicide circumstances, stressors, and risk factors was extracted and organized for analysis. Based on the indicated stressors (school, family, close relationship, social challenge, finance, risk behaviour, suicide exposure, others) and risk factors (health and mental health, history of self-harm, suicidality, and psychological maladjustment), cluster analysis was conducted to derive distinct profiles of student suicides.Results: A four-cluster solution was found. Patterns of stressors, risk factors, background characteristics and suicide circumstances within each cluster were examined. Four distinct and meaningful profiles of student suicides were characterised as "school distress", "hidden", "family and relationship", and "numerous issues".Conclusions: Findings highlighted the need to approach student suicides in meaningfully differentiated ways. Gathering suicide report data and generating evidence that advances our knowledge of student suicide profiles are important steps towards early identification and intervention. [ABSTRACT FROM AUTHOR]

Abstract Background The United Nations Interagency Group for Child Mortality Estimation (UNIGME) indicates that child mortality is the death rate of children between age zero to five. The importance of this area of research is high where worldwide a number of studies have been led on infant and child mortality, despite limited research discoveries with regards to Sri Lanka. The aim of this study is to investigate the socio-economic and demographic characteristics associated with child mortality in Sri Lanka. Methods Using the context of Sri Lanka as a case study, this study carried out based on data gathered from the micro level national survey. Using the logit regression model through the step-wise technique, the study investigate the socio-economic and demographic characteristics associated with child mortality in Sri Lanka. Results According to the generated results, place of residence province-wise, household head’s education level and source of drinking water have negative effect (lower risk) on child mortality in Sri Lanka. Exceptionally, the Western province has the highest negative effect on child mortality which demonstrates it as the least harmful region in Sri Lanka in child endurance. Household heads who owns private entities and Sri Lankan Moors has a positive effect on child mortality as well. Conclusion This study is helpful to address the population health of local arena and results can be supportive to the government and policymakers to gain an overview of physical health status of the country and able to uplift their policies based on the new findings.

Abstract 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.

BackgroundCountdown to 2015 was a multi-institution consortium tracking progress towards Millennium Development Goals (MDGs) 4 and 5. Case studies to explore factors contributing to progress (or lack of progress) in reproductive, maternal, newborn and child health (RMNCH) were undertaken in: Afghanistan, Bangladesh, China, Ethiopia, Kenya, Malawi, Niger, Pakistan, Peru, and Tanzania. This paper aims to identify cross-cutting themes on how and why these countries achieved or did not achieve MDG progress.MethodsApplying a standard evaluation framework, analyses of impact, coverage and equity were undertaken, including a mixed methods analysis of how these were influenced by national context and coverage determinants (including health systems, policies and financing).ResultsThe majority (7/10) of case study countries met MDG-4 with over two-thirds reduction in child mortality, but none met MDG-5a for 75 % reduction in maternal mortality, although six countries achieved >75 % of this target. None achieved MDG-5b regarding reproductive health. Rates of reduction in neonatal mortality were half or less that for post-neonatal child mortality. Coverage increased most for interventions administered at lower levels of the health system (e.g., immunisation, insecticide treated nets), and these experienced substantial political and financial support. These interventions were associated with ~30-40 % of child lives saved in 2012 compared to 2000, in Ethiopia, Malawi, Peru and Tanzania. Intrapartum care for mothers and newborns -- which require higher-level health workers, more infrastructure, and increased community engagement -- showed variable increases in coverage, and persistent equity gaps. Countries have explored different approaches to address these problems, including shifting interventions to the community setting and tasks to lower-level health workers.ConclusionsThese Countdown case studies underline the importance of consistent national investment and global attention for achieving improvements in RMNCH. Interventions with major global investments achieved higher levels of coverage, reduced equity gaps and improvements in associated health outcomes. Given many competing priorities for the Sustainable Development Goals era, it is essential to maintain attention to the unfinished RMNCH agenda, particularly health systems improvements for maternal and neonatal outcomes where progress has been slower, and to invest in data collection for monitoring progress and for rigorous analyses of how progress is achieved in different contexts.

Background: Diarrhoea is the second commonest cause of under-five mortality accounting for over half a million deaths annually. Although the prevalence of diarrhoea in Plateau State is lower than the national figure, the level remains high despite remarkable progress in the reduction of under-five mortality. This study seeks to determine the pattern of diarrhoea disease among under-fives in Plateau State.Methods: We extracted data from the Integrated Disease Surveillance and Response platform between January 2013 and December 2017 and analysed the trends of diarrhoea, age-specific case fatality rate (ASCFR), and seasonal patterns. We modelled the quarterly pattern of diarrhoea cases using additive time series and predicted the expected cases for 2018-2020.Results: We documented 60,935 cases of diarrhoea with age group 12-59 months having the highest number of cases (49.3%). The age group < 1 month had the highest ASCFR of 0.53%. Seasonal variation showed cases peaked in the first and third quarters of each year, except for the year 2016. The time series projection estimated 16,256, 17,645 and 19,034 cases in the year 2018, 2019 and 2020 respectively.Conclusion: Seasonal variation exists, and trends show an increased pattern of diarrhoeal disease among under-fives. There is a need to strengthen the implementation of diarrhoeal preventive and control strategy in the state and to improve the quality of data reporting. [ABSTRACT FROM AUTHOR]

Introduction: Malaria accounts for more than one-tenth of sub-Saharan Africa's 2.8 million annual childhood deaths, and remains a leading cause of post-neonatal child mortality in Uganda. Despite increased community-based treatment in Uganda, children continue to die because services fail to reach those most at risk. This study explores the influence of two key equity factors, socioeconomic position and rurality, on whether children with fever in eastern Uganda receive timely access to appropriate treatment for suspected malaria.Methods: This was a cross-sectional study in which data were collected from 1094 caregivers of children aged 6-59 months on: illness and care-seeking during the previous two weeks, treatment received, and treatment dosing schedule. Additional data on rurality and household socioeconomic position were extracted from the Iganga-Mayuge Health and Demographic Surveillance Site (HDSS) database. A child was considered to have received prompt and appropriate care for symptoms of malaria if they received the recommended drug in the recommended dosing schedule on the day of symptom onset or the next day. Unadjusted and adjusted logistic regression models were developed to explore associations of the two equity factors with the outcome. The STROBE checklist for observational studies guided reporting.Results: Seventy-four percent of children had symptoms of illness in the preceding two weeks, of which fever was the most common. Children from rural households were statistically more likely to receive prompt and appropriate treatment with artemisinin-combination therapy than their semi-urban counterparts (OR 2.32, CI 1.17-4.59, p = 0.016). This association remained significant following application of an adjusted regression model that included the age of the child, caregiver relationship, and household wealth index (OR 2.4, p = 0.036). Wealth index in its own right did not exert a significant effect for children with reported fever (OR for wealthiest quintile = 1.02, CI 0.48-2.15, p = 0.958).Conclusions: The findings from this study help to identify the role and importance of two key equity determinants on care seeking and treatment receipt for fever in children. Whilst results should be interpreted within the limitations of data and context, further studies have the potential to assist policy makers to target inequitable social and spatial variations in health outcomes as a key strategy in ending preventable child morbidity and mortality. [ABSTRACT FROM AUTHOR]

Background: Machine learning (ML) algorithms have been successfully employed for prediction of outcomes in clinical research. In this study, we have explored the application of ML-based algorithms to predict cause of death (CoD) from verbal autopsy records available through the Million Death Study (MDS).Methods: From MDS, 18826 unique childhood deaths at ages 1-59 months during the time period 2004-13 were selected for generating the prediction models of which over 70% of deaths were caused by six infectious diseases (pneumonia, diarrhoeal diseases, malaria, fever of unknown origin, meningitis/encephalitis, and measles). Six popular ML-based algorithms such as support vector machine, gradient boosting modeling, C5.0, artificial neural network, k-nearest neighbor, classification and regression tree were used for building the CoD prediction models.Results: SVM algorithm was the best performer with a prediction accuracy of over 0.8. The highest accuracy was found for diarrhoeal diseases (accuracy = 0.97) and the lowest was for meningitis/encephalitis (accuracy = 0.80). The top signs/symptoms for classification of these CoDs were also extracted for each of the diseases. A combination of signs/symptoms presented by the deceased individual can effectively lead to the CoD diagnosis.Conclusions: Overall, this study affirms that verbal autopsy tools are efficient in CoD diagnosis and that automated classification parameters captured through ML could be added to verbal autopsies to improve classification of causes of death. [ABSTRACT FROM AUTHOR]

Background: Many studies have been conducted on under-five mortality in India and most of them focused on the associations between individual-level factors and under-five mortality risks. On the contrary, only a scarce number of literatures talked about contextual level effect on under-five mortality. Hence, it is very important to have thorough study of under-five mortality at various levels. This can be done by applying multilevel analysis, a method that assesses both fixed and random effects in a single model. The multilevel analysis allows extracting the influence of individual and community characteristics on under-five mortality. Hence, this study would contribute substantially in understanding the under-five mortality from a different perspective., Method: The study used data from the Demographic and Health Survey (DHS) acquired in India, i.e., the fourth round of National Family and Health Survey (2015-16). It is a nationally representative repeated cross-sectional data. Multilevel Parametric Survival Model (MPSM) was employed to assess the influence of contextual correlates on the outcome. The assumption behind this study is that 'individuals' (i.e., level-1) are nested within 'districts' (i.e., level-2), and districts are enclosed within 'states' (i.e., level-3). This suggests that people have varying health conditions, residing in dissimilar communities with different characteristics., Results: Highest under-five mortality i.e., 3.85% are happening among those women whose birth interval is less than two years. In case of parity, around 4% under-five mortality is among women with Third and above order parity. Further, findings from the full model is that ICC values of 1.17 and 0.65% are the correlation of the likelihood of having under-five mortality risk among people residing in the state and district communities, respectively. Besides, the risk of dying was increased alarmingly in the first year of life and slowly to aged 3 years and then it remains steady., Conclusion: This study has revealed that both aspects viz. individual and contextual effect of the community are necessary to address the importance variations in under-five mortality in India. In order to ensure substantial reduction in under-five mortality, findings of the study support some policy initiatives that involves the need to think beyond individual level effects and considering contextual characteristics., (© 2024. The Author(s).)

Background: With 8,82,000 deaths in the under-five period, India observed varied intra-state and inter-regional differences across infant and child mortality in 2018. However, scarce literature is present to capture this unusual concentration of mortality in certain families by examining the association of the mortality risks among the siblings of those families along with various unobserved characteristics of the mother. Looking towards the regional and age differential in mortality, this paper attempts to provide evidence for the differential in mortality clustering among infants (aged 0-11 months), children (12-59 months) and under-five (0-59 months) period among mothers from the Empowered Action Group (EAG) and non-EAG regions of India.Methods: The study used data from the National Family Health Survey (2015-16) which includes all the birth histories of 475,457 women aged 15-49 years. Bivariate and multivariate analyses were used to fulfil the objectives of the study. A two-level random intercept Weibull regression model was used to account for the unexplained mother (family) level heterogeneity.Results: About 3.3% and 5.9% of infant deaths and 0.8% and 1.6% of childhood deaths were observed in non-EAG and EAG regions respectively. Among them, a higher percentage of infant and child death was observed due to the death of a previous sibling. There were 1.67 times [95% CI: 1.55-1.80] and 1.46 times [CI: 1.37-1.56] higher odds of infant and under-five mortality of index child respectively when the previous sibling at the time of conception of the index child was dead in the non-EAG regions. In contrast, the odds of death scarring (death of previous sibling scars the survival of index child) were 1.38 times [CI: 1.32-1.44] and 1.24 times [CI: 1.20-1.29] higher for infant and under-five mortality respectively in the EAG regions.Conclusion: The extent of infant and child mortality clustering and unobserved heterogeneity was higher among mothers in the non-EAG regions in comparison to their EAG region counterparts. With the growing situation of under-five mortality clustering in non-EAG states, region-wise interventions are recommended. Additionally, proper care is needed to ameliorate the inter-family variation in mortality risk among the children of both EAG and non-EAG regions throughout their childhood. [ABSTRACT FROM AUTHOR]

Background: Half of global child deaths occur in sub-Saharan Africa. Understanding child mortality patterns and risk factors will help inform interventions to reduce this heavy toll. The Nanoro Health and Demographic Surveillance System (HDSS), Burkina Faso was described previously, but patterns and potential drivers of heterogeneity in child mortality in the district had not been studied. Similar studies in other districts indicated proximity to health facilities as a risk factor, usually without distinction between facility types.Methods: Using Nanoro HDSS data from 2009 to 2013, we estimated the association between under-5 mortality and proximity to inpatient and outpatient health facilities, seasonality of death, age group, and standard demographic risk factors.Results: Living in homes 40-60 min and > 60 min travel time from an inpatient facility was associated with 1.52 (95% CI: 1.13-2.06) and 1.74 (95% CI: 1.27-2.40) greater hazard of under-5 mortality, respectively, than living in homes < 20 min from an inpatient facility. No such association was found for outpatient facilities. The wet season (July-November) was associated with 1.28 (95% CI: 1.07, 1.53) higher under-5 mortality than the dry season (December-June), likely reflecting the malaria season.Conclusions: Our results emphasize the importance of geographical proximity to health care, distinguish between inpatient and outpatient facilities, and also show a seasonal effect, probably driven by malaria. [ABSTRACT FROM AUTHOR]

Background: Measles accounts for high morbidity and mortality in children, especially in developing countries. In 2017, about 11,190 measles cases were recorded in Nigeria, including Bauchi State. The aim of this study was to describe the trend and burden of measles in Bauchi State, Nigeria.Method: We analyzed secondary data of measles cases extracted from the Measles Surveillance data system in Bauchi State from January 2013 to June 2018. The variables extracted included age, sex, doses of vaccination, case location and outcome. Data were analyzed using descriptive statistics, logistic regression, and multiplicative time series model (α = 0.05).Results: A total of 4935 suspected measles cases with an average annual incidence rate of 15.3 per 100,000 population and 57 deaths (Case Fatality Rate, CFR: 1.15%) were reported. Among the reported cases, 294 (6%;) were laboratory-confirmed, while clinically compatible and epi-linked cases were 402 (8%) and 3879 (70%), respectively. Of the 4935 measles cases, 2576 (52%) were males, 440 (9%) were under 1 year of age, and 3289 (67%) were between 1 and 4 years. The average annual incidence rate among the 1-4 year age-group was 70.3 per 100,000 population. The incidence rate was lowest in 2018 with 2.1 per 100,000 and highest in 2015 with 26.2 per 100,000 population. The measles cases variation index per quarter was highest in quarter 1 (198.86), followed by quarter 2 (62.21) and least in quarter 4 (10.37) of every year. Only 889 (18%) of the measles cases received at least one dose of measles vaccine, 2701 (54.7%) had no history of measles vaccination while 1346 (27.3%) had unknown vaccination status. The fatality of measles in Bauchi State were significantly associated with being under 5 years (AOR = 5.58; 95%CI: 2.19-14.22) and not having at least a dose of MCV (OR = 7.14; 95%CI: 3.70-14.29).Conclusion: Measles burden remains high in Bauchi State despite a decrease in its incidence over the study years. Most of the cases occurred in the first quarter of every year. Improved routine measles surveillance for prompt case management could reduce the burden of the disease in Bauchi State. [ABSTRACT FROM AUTHOR]

Background: There is a lack of nationwide studies on critically ill patients' health disparity under the National Health Insurance (NHI) system. We evaluated health disparities in intensive care unit (ICU) admission, outcomes, and readmission in impoverished children.Methods: We conducted a retrospective cohort study using a national database from the Korean NHI and Medical Aid Program (MAP). MAP supports the population whose household income is lower than 40% of the median Korean household income. We defined poverty as being a MAP beneficiary and compared the poverty and non-poverty groups. Patients between 28 days and 18 years old who were admitted to the ICU were included. Hospital mortality and readmission were analyzed with adjustment for patient characteristics, hospital type, and management procedures.Results: Out of 17,893 patients, 1153 (6.4%) patients were in poverty. The age-standardized ICU admission rate was higher in the poverty group (126.9 vs. 80.2 per 100,000 person-years). There was more age-standardized mortality in the poverty group (11.8 vs. 4.3 per 100,000 person-years). Patients in the poverty group did not have a statistically different risk of adjusted in-hospital mortality to those in the non-poverty group (odds ratio: 1.15, confidence interval [CI]: 0.84-1.55) but had a higher readmission rate (hazard ratio 1.25, CI 1.09-1.42).Conclusion: Under the NHI system, the disparity in pediatric critical care outcomes according to poverty is not definite, but the healthcare disparity in pre- and post-hospital care is a concern. Further studies are required to improve pre- and post-hospital healthcare quality of impoverished children. [ABSTRACT FROM AUTHOR]

Background: The United Nations Interagency Group for Child Mortality Estimation (UNIGME) indicates that child mortality is the death rate of children between age zero to five. The importance of this area of research is high where worldwide a number of studies have been led on infant and child mortality, despite limited research discoveries with regards to Sri Lanka. The aim of this study is to investigate the socio-economic and demographic characteristics associated with child mortality in Sri Lanka.Methods: Using the context of Sri Lanka as a case study, this study carried out based on data gathered from the micro level national survey. Using the logit regression model through the step-wise technique, the study investigate the socio-economic and demographic characteristics associated with child mortality in Sri Lanka.Results: According to the generated results, place of residence province-wise, household head's education level and source of drinking water have negative effect (lower risk) on child mortality in Sri Lanka. Exceptionally, the Western province has the highest negative effect on child mortality which demonstrates it as the least harmful region in Sri Lanka in child endurance. Household heads who owns private entities and Sri Lankan Moors has a positive effect on child mortality as well.Conclusion: This study is helpful to address the population health of local arena and results can be supportive to the government and policymakers to gain an overview of physical health status of the country and able to uplift their policies based on the new findings. [ABSTRACT FROM AUTHOR]

Background: Children in resource-limited countries are more likely to die from treatable conditions than those in higher resource settings due to a lack of the right essential medicine at the right time. Globally millions of children die every year from conditions that could be treatable with existing medicines before they reach their fifth birthday. This study aimed in assessing the availability and affordability of essential medicine for children in selected health facilities of southern nations, nationalities, and peoples' regions (SNNPR), Ethiopia.Method: A medicine outlets-based cross-sectional study was conducted to assess the availability, affordability, and prices of the 30 selected essential medicines (EMs) for children in 30 public and 30 private medicine outlets in SNNPR from March 29 to May 5, 2019, applying WHO and Health Action International (HAI) tools. Availability was expressed as the percentage of sampled medicine outlets per sector that the surveyed medicine was found on the day of data collection. The amount of daily wages required for the lowest-paid government unskilled worker (LPGW) to buy one standard treatment of an acute condition or treatment for a chronic condition for a month was used to measure affordability and median price ratio for the price of EMs.the Results: Availability varied by sector, type of medication, and level of health facilities. The average availability of EM was 57.67% for the public sector and 53.67% for the private sector. Ceftriaxone, SOR, zinc sulfate, and cotrimoxazole were the most widely available types of medications in the two sectors. The median price ratios (MPR) for the cheapest drugs LP were 1.26 and 2.24 times higher than their International Reference Price (IRP) in the public and private sectors respectively. Eighty-two percent of LP medicines in the public and 91 % of LP medicines in the private sectors used in the treatments of prevalent common conditions in the region were unaffordable as they cost a day's or more wages for the LPGW.Conclusion: Availability, affordability, and price are determinant pre-requisite for EMs access. According to the current work, although fair availability was achieved, the observed high price affected affordability and hence access to EMs. [ABSTRACT FROM AUTHOR]

Background: This study aims to assess the interactive effects of Brazilian public interventions, environmental health programs (access to water, sanitation and solid waste collection) and a Conditional Cash Transfer Program (PBF), on the mortality reduction due to diarrhea and malnutrition among children under 5 years old.Methods: The study design is ecological, with longitudinal analysis in a balanced panel. The period covered is 2006 to 2016, including 3467 municipalities from all regions of the country, which resulted in 38,137 observations. The generalized linear models were adjusted considering the Negative Binomial (NB) distribution for the number of deaths due to malnutrition and diarrhea, with fixed effects. NB models with and without zero-inflation were assessed. Subsequent interaction models were applied to assess the combined effects of the two public policies.Results: In relation to the decline of mortality rates due to diarrhea in the municipalities, positive effect modification were observed in the presence of: high coverage of the target population by the PBF and access to water, 0.54 (0.28-1.04) / 0.55 (0.29-1.04); high coverage by the total population by the PBF and access to water, 0.97 (0.95-1.00) and high coverage by the total population by the PBF and access to sanitation, 0.98 (0.97-1.00). Decline on diarrhea mortality was also observed in the joint presence of high coverage of solid waste collection and access to water, categories 1 (> 60% ≤85%): 0.98 (0.96-1.00), 0.98 (0.97-1, 00) and 2 (> 85% ≤ 100%): 0.97 (0.95-0.98), 0.97 (0.95-0.99). Negative effect modification were observed for mortality due to malnutrition in the presence of simultaneous high coverage of the total population by the PBF and access to sanitation categories 1 (≥ 20 < 50%): 1.0061 (0.9991-1.0132) and 2 (≥ 50 < 100%): 1.0073 (1.0002-1.0145) and high coverage of the total population by the PBF and solid waste collection, 1.0004 (1.0002-1.0005), resulting in malnutrition mortality rates increase.Conclusion: Implementation of environmental health services and the coverage expansion by the PBF may enhance the prevention of early deaths in children under 5 years old due to diarrhea, a poverty related disease. [ABSTRACT FROM AUTHOR]

Background: Globally, child mortality rate has remained high over the years, but the figure can be reduced through proper implementation of spatially-targeted public health policies. Due to its alarming rate in comparison to North American standards, child mortality is particularly a health concern in Mexico. Despite this fact, there remains a dearth of studies that address its spatio-temporal identification in the country. The aims of this study are i) to model the evolution of child mortality risk at the municipality level in Greater Mexico City, (ii) to identify municipalities with high, medium, and low risk over time, and (iii) using municipality trends, to ascertain potential high-risk municipalities.Methods: In order to control for the space-time patterns of data, the study performs a Bayesian spatio-temporal analysis. This methodology permits the modelling of the geographical variation of child mortality risk across municipalities, within the studied time span.Results: The analysis shows that most of the high-risk municipalities were in the east, along with a few in the north and west areas of Greater Mexico City. In some of them, it is possible to distinguish an increasing trend in child mortality risk. The outcomes highlight municipalities currently presenting a medium risk but liable to become high risk, given their trend, after the studied period. Finally, the likelihood of child mortality risk illustrates an overall decreasing tendency throughout the 7-year studied period.Conclusions: The identification of high-risk municipalities and risk trends may provide a useful input for policymakers seeking to reduce the incidence of child mortality. The results provide evidence that supports the use of geographical targeting in policy interventions. [ABSTRACT FROM AUTHOR]

Background: Globally, diarrhoea is the second leading cause of death in children under five and a major public health problem. Despite several health care initiatives taken by the government, a large proportion of children still experience diarrhoeal diseases which cause high childhood death in India. This study aims to examine the socio-demographic and environmental factors associated with diarrhoea in children under five in India.Methods: A cross-sectional study was designed using secondary data from the recent round of the National Family Health Survey (NFHS-4), conducted in 2015-16. A total of 247,743 living children below 5 years of age were included in the analysis. Bivariate and multivariate logistic regression models were carried out to assess the factors associated with childhood diarrhoeal disease.Results: In India, about 9% of under-five children experience diarrhoeal disease in the past 2 weeks preceding the survey. Children living in rural areas (Adjusted odds ratio [aOR]: 1.05; 95% CI: 1.01, 1.09), children belonged to scheduled tribe (aOR: 0.83; 95% CI: 0.79, 0.89) and other castes (aOR: 0.92; 95% CI: 0.88, 0.97), Muslim children (aOR: 1.18; 95% CI: 1.13, 1.24), and children resided in the central (aOR: 1.61; 95% CI: 1.52, 1.70) and west (aOR: 1.08; 95% CI: 1.01, 1.15) regions were significantly associated with higher likelihood of diarrhoea in the past 2 weeks. Concerning environmental factors, child stool disposal (aOR: 1.06; 95% CI: 0.98, 1.09), floor materials (aOR: 1.08; 95% CI: 1.03, 1.12) and roof materials (aOR: 1.08; 95% CI: 1.04, 1.13) of the household were found to be significant predictors of childhood diarrhoea occurrence.Conclusions: Diarrhoeal disease is common among children who lived in rural areas, scheduled castes, Muslims, and children from poor families. Regarding environmental factors, stool disposal practices in the household, dirt floor, and thatch roof materials of the household unit are risk factors for diarrhoeal disease. Targeted approach should be initiated to mitigate the problem of the poor health status of children by providing adequate health care. The policy-makers and stakeholders should address adverse environmental conditions by the provision of latrine and improved housing facilities. [ABSTRACT FROM AUTHOR]

Background: Under-five mortality in Chad reached a minimum value of 119 deaths per 1000 live births in 2018, compared with a maximum of 250 in 1972. Despite this decline in the  mortality trend, for every six children in Chad, one dies before the age of five. This study, therefore, investigated the proximate, intermediate, and distal determinants of under-five mortality in Chad.Methods: We used data from the 2014-15 Chad's Demographic and Health Survey. Data of 7782 children below 5 years were used for the study. Both descriptive and multivariable hierarchical logistic regression analyses were performed. Statistical significance was declared at p < 0.05.Results: Under-five mortality was found to be 130 deaths per 1000 live births in Chad, with variations across the various population sub-groups. For distal predictors, the likelihood of death was higher in children born in the FChari Baguirmi region (AOR = 3.83, 95% CI: 1.81-8.14). Children whose mothers belonged to the Baguirmi/Barma ethnic group (AOR = 8.04, 95% CI: 1.75-36.99) were more likely to die before the age of five. On the contrary, the likelihood of under-five mortality was low among children born in rural areas (AOR = 0.73, 95% CI: 0.55-0.97). With the intermediate predictors, the likelihood of under-five deaths was higher among children whose mothers had no formal education (AOR = 1.72, 95% CI: 1.06-2.77). Regarding the proximate predictors, the odds of under-five deaths was higher among male children (AOR = 1.03, 95% CI: 1.05-1.63) and first rank children (AOR = 1.58, 95% CI: 1.13-2.21).Conclusion: The study found that the determinants of under-five mortality in Chad are region of residence, place of residence, ethnicity, education, sex of child, and birth rank. These findings show that both socio-economic and proximate factors explain the disparities in under-five mortality in Chad. The identification of these factors can be pivotal towards the design of evidence-based interventions intended to improve child survival. Therefore, improving maternal education while refocusing and re-packaging existing strategies to target selected sub-regional populations with high under-five mortality is urgently required. [ABSTRACT FROM AUTHOR]