Search

Background: This study systematically reviewed the causes of child death across different age groups based on the International Classification of Diseases, 10th Revision (ICD-10) criteria. Methods: A comprehensive search was conducted in seven electronic databases and two search engines to identify all studies examining child mortality in any part of Iran or the entire country. Hand searching, gray literature, and bibliographies were also utilized. Data were synthesized descriptively and through meta-analysis. Results: A total of 35 studies were included, encompassing 58,519 death cases across various age groups. According to the ICD-10 classification, the most common causes of Neonatal Mortality Rates (NMR) were pregnancy, childbirth, and puerperium-related conditions (41.1%), congenital malformations (19.2%), and certain conditions originating in the perinatal period (14.5%). For Infant Mortality Rates (IMR), the leading causes were congenital malformations (44.0%), pregnancy, childbirth, and related conditions (14.5%), and respiratory and cardiovascular diseases (8.7%). In the age group of 28 days to 5 years, the primary causes of death were pregnancy, childbirth, and puerperium-related issues (27.5%), congenital malformations and chromosomal abnormalities (21.6%), and respiratory and cardiovascular disease (9.3%). For children aged 1 to 5 years, congenital malformations (29.1%), external causes (19.6%), and respiratory and cardiovascular disorders (7.2%) were the most significant causes of death. The meta-analysis revealed that immaturity [0.171 (PI: 0.032–0.561)] in infants aged 0–28 days, and congenital malformations in the age groups of 28 to 1 year [0.261 (PI: 0.166–0.385)] and 28 to 5 years [0.173 (PI: 0.078–0.342)] were the leading causes of death. Conclusions: The findings of this study provide valuable insights for priority-setting interventions aimed at reducing child mortality according to the prevalence rate of specific causes in different age groups. [ABSTRACT FROM AUTHOR]

Children are not born equal in their likelihood of survival. The risk of mortality is highest during and shortly after birth. In the immediate postnatal period and beyond, perinatal events, nutrition, infections, family and environmental exposures, and health services largely determine the risk of death. We argue that current public health programmes do not fully acknowledge this spectrum of risk or respond accordingly. As a result, opportunities to improve the care, survival, and development of children in resource-poor settings are overlooked. Children at high risk of mortality are underidentified and commonly treated using guidelines that do not differentiate care according to the magnitude or drivers of those risks. Children at low risk of mortality are often provided with more intensive care than needed, disproportionately using limited health-care resources with minimal or no benefits. Declines in newborn, infant, and child mortality rates globally are slowing, and further reductions are likely to be incrementally more difficult to achieve once simple, high impact interventions have been universally implemented. Currently, 63 countries have rates of neonatal mortality that are off track to meet the Sustainable Development Goal 2030 target of 12 deaths per 1000 livebirths or less, and 54 countries have rates of mortality in children younger than 5 years that are off track to meet the target of 25 deaths per 1000 livebirths or less. If these targets are to be met, a change of approach is needed to address infant and child mortality and for health-care systems to more efficiently address residual mortality. [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: Strengthening healthcare systems is a practical approach to enhance healthcare delivery and services. Although there has been a rise in the number of health systems strengthening (HSS) interventions in sub-Saharan Africa (SSA), there is limited evidence on the causal effect of these activities on child survival. Furthermore, the findings reported so far have been varied, and how they relate to each other remains unclear. This systematic review study aims to assess all available evidence to understand the impact of HSS activities on child survival in SSA. Methods: We developed a search strategy to retrieve all relevant studies from electronic databases such as PubMed/MEDLINE, Web of Science, and African Journals Online. We will use a combination of search terms such as "under-five mortality," "child mortality," "infant mortality," "neonatal mortality," "child survival," and "health systems strengthening." The review will include studies that establish a causal relationship between HSS interventions and child survival. This will include studies with designs such as randomized controlled trials and quasi-experimental and methods like difference-in-difference. Two reviewers will independently screen all citations, abstracts, and full-text data and a third reviewer will act as a tiebreaker in case of disagreements. The primary outcome of interest is the impact of HSS activities on under-five survival. We will evaluate the quality of each study using the Bradford Hill criteria for causation. Discussion: Our systematic review will identify and evaluate all relevant evidence that establishes a causal relationship between HSS activities and the survival of children under five years in SSA. The review's findings regarding the impact of HSS activities on child survival could be of significant interest to the donor community and policy actors in the region. We also anticipate that the review's conclusions could serve as a valuable guide for the development of future health system interventions and strategies in SSA. Systematic review registration: PROSPERO CRD42022333913. [ABSTRACT FROM AUTHOR]

Objective: Child mortality and stillbirth rates (SBR) remain high in low‐income countries but may be underestimated due to incomplete reporting of child deaths in retrospective pregnancy/birth histories. The aim of this study is to compare stillbirth and mortality estimates derived using two different methods: the method assuming full information and the prospective method. Methods: Bandim Health Project's Health and Demographic Surveillance Systems (HDSS) follows women of reproductive age and children under five through routine home visits every 1, 2 or 6 months. Between 2012 and 2020, we estimated and compared early neonatal (ENMR, <7 days), neonatal (NMR, <28 days), and infant mortality (IMR, <1 year) per 1000 live births and SBR per 1000 births. Risk time for children born to registered women was calculated from birth (the method assuming full information) versus date of first observation in the HDSS (the prospective method), either at birth (for pregnancy registration) or registration. Rates were calculated using the Kaplan–Meier estimator and compared in generalised linear models allowing for within‐child correlation obtaining relative risks (RR). Results: We registered and followed 29,413 infants (1380 deaths; 1459 stillbirths) prospectively. An additional 164 infant deaths and 129 stillbirths were registered retrospectively and included in the method assuming full information. The ENMR was 24.5 (95%CI: 22.6–26.4) for the method assuming full information and 25.8 (23.7–27.8) for the prospective method, RR = 0.96 (0.93–0.99). Differences were smaller for the NMRs and IMRs. For SBRs, the estimates were 53.5 (50.9–56.0) and 58.6 (55.7–61.5); RR = 0.91 (0.90–0.93). The difference between methods became more pronounced when the analysis was limited to areas visited every 6 months: RR for ENMR: 0.91 (0.86–0.96) and RR for SBR: 0.85 (0.83–0.87). Conclusions: Assuming full information underestimates SBR and ENMR. Accounting for omissions of stillbirths and early neonatal deaths may lead to more accurate estimates and improved ability to monitor mortality. [ABSTRACT FROM AUTHOR]

Background: The prevalence of Short Birth Interval (SBI) is higher in Low- and Middle-Income countries (LMICs), including Bangladesh. Previous studies in LMICs have estimated the effects of SBI on child mortality by comparing two unequal groups of mothers based on their socio-economic status. This approach may lead to overestimation or underestimation of the true effect of birth interval on child mortality, particularly when sample sizes are relatively small. Objective: We determined the effects of SBI on several forms of child mortality in Bangladesh by comparing two equal groups created by applying the propensity score matching technique. Methods: This study analyzed data from 5,941 mothers and 1,594 health facilities extracted from the 2017/18 Bangladesh Demographic and Health Survey and the 2017 Bangladesh Health Facility Survey. The exposure variable was SBI (defined as the interval between two subsequent births <33 months: yes, no), while the outcome variables were neonatal mortality (defined as mortality within 28 days of birth: yes, no), infant mortality (defined as mortality within 1 year of birth: yes, no), and under-five mortality (defined as mortality within 5 years of birth: yes, no). Multilevel Poisson regression based on inverse probability treatment weights was used to determine the association between exposure and outcome variables. Results: The prevalence rates of neonatal, infant, and under-five mortality were 48.8, 30.8, and 23.1 per 1000 live births, respectively. Newborns of SBI mothers were found to have a 63% higher likelihood of neonatal mortality (aPR, 1.63; 95% CI, 1.08–2.46) compared to newborns of non-SBI mothers. Furthermore, the prevalence of infant mortality and under-five mortality was 1.45 times higher (aPR, 1.45; 95% CI, 1.01–2.08) and 2.82 times higher (aPR, 2.82; 95% CI, 2.16–3.70), respectively, among babies born in a short interval of their immediately preceding sibling as compared to babies born in a normal interval of their immediately preceding sibling. Conclusions: Findings of this study indicate that SBI is an important predictor of child mortality. Consequently, around 1 million children born in a short interval every year in Bangladesh are at risk of dying before reaching their fifth birthday. This indicates a challenge for Bangladesh to achieve the SDG 3 target to reduce neonatal and under-five mortality to 12 and 25 deaths per 1000 live births, respectively. Hence, awareness-building programs about the adverse effects of SBI and strengthening existing healthcare facilities are important. [ABSTRACT FROM AUTHOR]

Objective The aim of the study is to examine the impact of maternal interpregnancy body mass index (BMI) change on subsequent offspring mortality risk. Study Design This is a retrospective cohort study of women who had two consecutive live singleton deliveries of at least 20 weeks' gestation from the Utah Population Database. Our exposure was defined as interpregnancy BMI change from the date of first delivery to the conception date of subsequent pregnancy. We categorized BMI change as: < − 1, −1 to 0, 0 to <1 (reference), 1 to 2, 2 to 4, ≥4 kg/m 2. Our primary outcome was all-cause age-specific mortality during four time periods: neonatal (≤28 days), infant (29 days to <1 year old), childhood ((≥1 to <5 years old), and late childhood (5 to <18 years old). We also examined mortality specifically attributed to congenital anomalies. Analyses used Cox proportional hazard models stratified by full term (≥37 weeks) and preterm (<37 weeks) deliveries. All models were adjusted for relevant confounders. Results Of 266,752 women, among full-term deliveries, women with a BMI increase of 4 kg/m 2 or more had an increased risk of neonatal mortality in their subsequent pregnancy (hazard ratio or HR = 1.72, 95% confidence interval or CI: 1.23–2.41) Women who lost 1 kg/m 2 or more between deliveries also had increased neonatal mortality (HR = 1.46, 95% CI: 1.04–2.05). There were no differences in infant, early, or late childhood mortality by interpregnancy BMI change. Maternal interpregnancy interval weight loss of 1 kg/m 2 or more and weight gain of ≥4 kg/m 2 also had increased risk of mortality associated with congenital anomalies or conditions arising during the neonatal period following their subsequent delivery. Conclusion Women with significant interpregnancy weight gain and modest weight loss have a significant increased risk of neonatal mortality following their subsequent pregnancy. Key Points Significant weight gain between deliveries increases the risk of neonatal death. Modest weight loss between deliveries increases the risk of neonatal death. This risk may be partially explained by increased risk of congenital malformations. [ABSTRACT FROM AUTHOR]

Low and middle-income countries continue to use Verbal autopsies (VAs) as a World Health Organisation-recommended method to ascertain causes of death in settings where coverage of vital registration systems is not yet comprehensive. Whilst the adoption of VA has resulted in major improvements in estimating cause-specific mortality in many settings, well documented limitations have been identified relating to the standardisation of the processes involved. The WHO has invested significant resources into addressing concerns in some of these areas; there however remains enduring challenges particularly in operationalising VA surveys for deaths amongst women and children, challenges which have measurable impacts on the quality of data collected and on the accuracy of determining the final cause of death. In this paper we describe some of our key experiences and recommendations in conducting VAs from over two decades of evaluating seminal trials of maternal and child health interventions in rural Ghana. We focus on challenges along the entire VA pathway that can impact on the success rates of ascertaining the final cause of death, and lessons we have learned to optimise the procedures. We highlight our experiences of the value of the open history narratives in VAs and the training and skills required to optimise the quality of the information collected. We describe key issues in methods for ascertaining cause of death and argue that both automated and physician-based methods can be valid depending on the setting. We further summarise how increasingly popular information technology methods may be used to facilitate the processes described. Verbal autopsy is a vital means of increasing the coverage of accurate mortality statistics in low- and middle-income settings, however operationalisation remains problematic. The lessons we share here in conducting VAs within a long-term surveillance system in Ghana will be applicable to researchers and policymakers in many similar settings. [ABSTRACT FROM AUTHOR]

BackgroundNeonatal mortality rate (NMR), infant mortality rate (IMR), and child mortality rate (CMR) show a huge difference across countries, which has been posing challenges for public health policies and medical resource allocation.MethodsBayesian spatiotemporal model is applied to assess the detailed spatiotemporal evolution of NMR, IMR, and CMR from a global perspective. Panel data from 185 countries from 1990 to 2019 are collected.ResultsThe continuously decreasing trend of NMR, IMR, and CMR indicated a great improvement in neonatal, infant, and child mortality worldwide. Further, huge differences in the NMR, IMR, and CMR still exist across countries. In addition, the gap of NMR, IMR, and CMR across the countries presented a widening trend from the perspective of dispersion degree and kernel densities. The spatiotemporal heterogeneities demonstrated that the decline degree among these three indicators could be observed as CMR > IMR > NMR. Countries such as Brazil, Sweden, Libya, Myanmar, Thailand, Uzbekistan, Greece, and Zimbabwe showed the highest values of b1i, indicating a weaker downward trend compared to the overall downward trend in the world.ConclusionsThis study revealed the spatiotemporal patterns and trends in the levels and improvement of NMR, IMR, and CMR across countries. Further, NMR, IMR, and CMR show a continuously decreasing trend, but the differences in improvement degree present a widening trend across countries. This study provides further implications for policy in newborns, infants, and children's health to reduce health inequality worldwide.

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]

While several studies have examined the effect of Foreign Direct Investment (FDI) on economic development indicators, most of these studies focused on economic growth with very little attention paid to health outcomes. Moreover, among the studies that took account of health outcomes, none of them investigated the effect of FDI on child health outcomes across a sample of African countries. However, focusing on African countries is very important because sub-Saharan Africa (SSA) has the highest rate of child mortality in the world. This study, therefore, investigates the effect of FDI on child health outcomes in 39 African countries from 1980 to 2018. Neonatal and infant mortality rates are used to proxy child health outcomes. The baseline estimation technique employed is the Fixed Effects (FE) regression. However, to deal with potential endogeneity, we employ the system Generalised Method of Moments (GMM) regression as the robustness estimation technique. Our findings show that, FDI improves child health outcomes, especially through economic growth after controlling for endogeneity. Thus, in African governments' quest to reduce child mortality, a major useful strategy could be attracting more FDI inflows. [ABSTRACT FROM AUTHOR]

Africa is estimated to lose a very significant number of high‐skilled individuals through emigration. This has resulted in a number of studies investigating the effect of high‐skilled emigration on socio‐economic indicators in Africa. Notwithstanding, the majority of these studies have examined the effect of high‐skilled emigration on economic growth, with less attention paid to health outcomes. Meanwhile, health outcomes, especially child health outcomes, have major implications for future human capital and overall economic development. With sub‐Saharan Africa (SSA) having the highest child mortality rate in the world, this study, therefore, investigates the effect of the emigration of high‐skilled individuals on child health in 48 African countries for the period, 1985–2010. Neonatal mortality and infant mortality rates are used to proxy child health. The panel fixed effects and the dynamic panel system Generalised Methods of Moments (GMM) regressions are employed as estimation techniques. Using the panel fixed effects, we find that, while the emigration of high‐skilled individuals is detrimental to neonatal mortality, in the case of infant mortality, it is insignificant. However, after controlling for endogeneity using the dynamic panel system GMM, the emigration of high‐skilled individuals is found to be detrimental to both neonatal mortality and infant mortality. The results suggest that, in order to enhance child mortality in Africa, attention should be paid towards decreasing high‐skilled emigration on the continent. [ABSTRACT FROM AUTHOR]

This paper examines the effect of maternal healthcare utilization on early neonatal, neonatal and post-neonatal mortality in India using the recent round of National Family Health Survey (NFHS-4) data. At the national level, for the last live birth of women during the five year preceding the survey, the early neonatal mortality rate was about 16, neonatal mortality rate was 19 and post-neonatal mortality was 7 per thousand live births. Also, only one-fifth of women who had a birth in the past five years received full antenatal care (ANC), 83 percent women received safe delivery and 65 percent women received post-natal care. Findings of the study indicate that full ANC and postnatal care were significantly associated with early neonatal and neonatal mortality. However, no significant association between safe delivery and newborn mortality were found after adjusting the socio-economic and demographic characteristics. Therefore, for a policy point of view, there is a dire need to strengthen supply dependent factors regarding public awareness, accessibility, and affordability of maternal and child healthcare services. It is also necessary to focus on increasing utilization along with continuum of care of maternal and child healthcare services to sustain the reduction in mortality during infancy. [ABSTRACT FROM AUTHOR]

The article focuses on study conducted to understand the difference in the neonatal and child mortality in high-(HIC) and low-income (LIC) countries. Topics discussed include Millennium Development Goals (MDGs) put up by United Nations Member States to fight poverty and hunger, improve education, and gender equality; difference in neonatal mortality between countries according the data presented in the Sustainable Development Report 2021; and influence of COVID-19 pandemic on perinatal care.

The paper examines risk factors associated with child mortality in the scheduled tribe population in India and explains differences in child mortality outcomes between the scheduled tribe and the non-scheduled tribe population. A weighted total of 7,962 deaths of children aged under 5 years occurred within the 5 years preceding the survey in our pooled sample of NFHS 3 and NFHS 4 where scheduled tribe children contribute approximately 59% of the death. A Cox proportional hazard regression is estimated using several predictors. The findings suggest that there is a significant decline in neonatal, infant and under-five mortality among the tribal population in the last 10 years. Cox regression results indicate that timely implementation of ante-natal care, postnatal care and institutional delivery are important factors behind the reduction in neonatal as well as infant mortality in tribal-dominated areas; whereas proper family planning method, lower birth order of the child and maternal education, media exposure along with autonomy of mother are effective in reducing under-five mortality. Further, early initiation of breastfeeding and exclusive breastfeeding can reduce child mortality more effectively. Therefore, policies and programmes on maternal care and family planning, and the creation of awareness at the community level on reproductive maternal and child health will need to be emphasised to reduce child mortality in the tribal population. [ABSTRACT FROM AUTHOR]

Background: The mortality pattern from birth to age five is known to vary by underlying cause of mortality, which has been documented in multiple instances. Many countries without high functioning vital registration systems could benefit from estimates of age- and cause-specific mortality to inform health programming, however, to date the causes of under-five death have only been described for broad age categories such as for neonates (0–27 days), infants (0–11 months), and children age 12–59 months. Methods: We adapt the log quadratic model to mortality patterns for children under five to all-cause child mortality and then to age- and cause-specific mortality (U5ACSM). We apply these methods to empirical sample registration system mortality data in China from 1996 to 2015. Based on these empirical data, we simulate probabilities of mortality in the case when the true relationships between age and mortality by cause are known. Results: We estimate U5ACSM within 0.1–0.7 deaths per 1000 livebirths in hold out strata for life tables constructed from the China sample registration system, representing considerable improvement compared to an error of 1.2 per 1000 livebirths using a standard approach. This improved prediction error for U5ACSM is consistently demonstrated for all-cause as well as pneumonia- and injury-specific mortality. We also consistently identified cause-specific mortality patterns in simulated mortality scenarios. Conclusion: The log quadratic model is a significant improvement over the standard approach for deriving U5ACSM based on both simulation and empirical results. [ABSTRACT FROM AUTHOR]

This article analyses the long‐term development of social class differences in infant and child mortality in an area of southern Sweden, spanning from the early stages of the mortality transition at the beginning of the nineteenth century, to the late 1960s when both infant and child mortality had reached very low levels. Our findings show that infant and child mortality was fairly equal at the beginning of the study period. We find no clear pattern of class differentials in childhood mortality in the first half of the nineteenth century when both infant and child mortality declined. Later in the nineteenth century, class differences started to emerge. This is clear for both post‐neonatal mortality and child mortality, while we do not find any class differences in neonatal mortality. Over time, a more or less full gradient emerged for post‐neonatal mortality, and a weak gradient also emerged for child mortality. Strikingly, the disadvantaged position for unskilled and lower‐skilled workers remained throughout the 1960s, also at a time when mortality levels were very low, and living standards had increased dramatically for all classes in the population. [ABSTRACT FROM AUTHOR]

• Post hoc analysis of the effect of introducing oral BCG in Northern Sweden, 1927–31. • BCG was voluntary and mostly not provided to sick or moribund neonates. • Receiving BCG was associated with a ~80% reduction in tuberculosis deaths. • BCG appeared to protect against death from other respiratory infections. Following the introduction of oral Bacille Calmette-Guérin (BCG) a century ago, Albert Calmette suggested that BCG both provided protection against death from tuberculosis (TB) and other causes. The findings were not pursued. Today, there is considerable evidence that intradermal BCG have beneficial non-specific effects (NSEs). We re-analyzed data from BCG's introduction 1927–1931 in Sweden hypothesizing that BCG reduced infectious deaths. In three papers published by Dr Carl Näslund, the progress of oral neonatal BCG rollout provided free-of-charge and the effects on child mortality in the highly TB-prevalent region Norrbotten was sequentially updated. We analyzed cause-specific post-neonatal mortality by vaccination status excluding deaths from congenital conditions. Due to apparent differences in effects during study years, effects were assessed overall and separately in two periods (1927–1929, 1930–1931). According to Näslund, TB households were slightly more likely to accept vaccination; fewer newborns that were sick or had congenital problems were vaccinated. BCG coverage was 28.3% (5659/20,012); 8.7% (1746/20,012) died. The BCG/unvaccinated Risk Ratio (RR) of post-neonatal childhood death was 0.53 (0.45–0.62). BCG was associated with 80% (49–92%) reduced mortality from TB. From 1927 to 29, BCG appeared to protect strongly against deaths from all diseases, including the non-infectious, RR = 0.09 (0.02–0.36), presumably reflecting selection bias. From 1930 to 1931, there was no protection against non-infectious deaths, RR = 0.92 (0.49–1.70) indicating less bias (p = 0.004 for same effect). During 1930–1931, BCG was associated with reductions in non-TB infectious deaths (RR = 0.75 (0.58–0.97)); 2/3 were caused by respiratory infections, against which the BCG/unvaccinated RR was 0.61 (0.43–0.84). Other causes of death were less frequent and provided no clear pattern, except that BCG was associated with more meningitis deaths, RR = 6.85 (2.20–21.4). Healthy vaccinee bias, particularly in 1927–1929, resulted in strongly beneficial overall BCG effects. However, the 1930–1931 data provided some support that BCG both protected against TB deaths and deaths from respiratory infections. [ABSTRACT FROM AUTHOR]

Introduction: Vital registration is an important element in health information systems which can inform policy and strengthen health systems. Mexico has a well-functioning vital registration system; however, there is still room for improvement, especially for deaths of children under 5. This study assesses the quality of the vital registration system in capturing deaths and evaluates the quality of cause of death certification in under-5 deaths in Yucatan, Mexico. Methods: We collected information on under-5 deaths that occurred in 2015 and 2016 in Yucatan, Mexico. We calculated the Vital Statistics Performance Index (VSPI) to have a general assessment of the vital registration performance. We examined the agreement between vital registration records and medical records at the individual and population levels using the chance-corrected concordance (CCC) and cause-specific mortality fraction (CSMF) accuracy as quality metrics. Results: We identified 966 records from the vital registry for all under-5 deaths, and 390 were linked to medical records of deaths occurring at public hospitals. The Yucatan vital registration system captured 94.8% of the expected under-5 deaths, with an overall VSPI score of 87.2%. Concordance between underlying cause of death listed in the vital registry and the cause determined by the medical record review varied substantially across causes, with a mean overall chance-corrected concordance across causes of 6.9% for neonates and 46.9% for children. Children had the highest concordance for digestive diseases, and neonates had the highest concordance for meningitis/sepsis. At the population level, the CSMF accuracy for identifying the underlying cause listed was 35.3% for neonates and 67.7% for children. Conclusions: Although the vital registration system has overall good performance, there are still problems in information about causes of death for children under 5 that are related mostly to certification of the causes of death. The accuracy of information can vary substantially across age groups and causes, with causes reported for neonates being generally less reliable than those for older children. Results highlight the need to implement strategies to improve the certification of causes of death in this population. [ABSTRACT FROM AUTHOR]

Objective: To describe the spatio-temporal distribution of infant mortality and its components in the city of Rio de Janeiro, Brazil, in 2010 and 2019. Methods: Infant mortality rate and the neonatal and postneonatal components were estimated. The standardized mortality rate was calculated to detect excess child mortality in the planning areas. Poisson regression was performed to estimate the effect of these planning areas on the years 2010 and 2019. Spatial analysis per neighborhoods was performed to identify the spatial autocorrelation rates, using the Moran's Index and local indicator of spatial association (LISA). Results: The planning areas are very heterogeneous, depending on the history and evolution of occupation. There is an excess of mortality in planning areas with greater social vulnerability. In the Poisson model, it was observed that in all components, the planning area (PA) of residence was statistically significant as well as the year. Moran's index did not show global spatial autocorrelation. However, when applying the LISA method, autocorrelation was observed at the local level and spatial clusters in the municipality of Rio de Janeiro. Conclusions: The spatial heterogeneity of the infant mortality rate in Rio de Janeiro suggests that local health policy strategies of each region consist in an efficient measure for reducing this rate. [ABSTRACT FROM AUTHOR]

This article uses a nation-wide household survey data from India and identifies important predictors of neonatal and infant mortality using multiple machine learning (ML) techniques. The consensus on the leading predictors from the interpretable ML algorithms (that we use) serve as early warning signs of neonatal and infant mortality. This enables us to identify a 'high-mortality risk' group of mothers and infants – an important goal of India's 'India Newborn Action Plan'. This high-risk group comprises firstborns, mothers with prior deaths or several previous births, newborns suffering from complicated deliveries, small size at birth and unvaccinated infants. We identify early newborn care, folic acid supplements and conditional cash transfer (Janani Suraksha Yojana) as the most effective policy interventions. Given the imbalanced nature of the dependent variable ('events' being rarer than 'non-events') we use additional ML methods (along with the commonly used ones) that are tailor-made for 'rare-event' prediction for robustness checks. We also use an evaluation measure called Area under Precision Recall Curve that is tailored for measuring prediction accuracy with imbalanced data. Our analysis sheds light on policy relevance and suggests some new policy prescriptions such as close monitoring of at-risks babies including females and those with small birth-size. [ABSTRACT FROM AUTHOR]

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The article focuses on the importance of neonatal resuscitation to reduce neonatal mortality, particularly in low-resource settings. It discusses the effectiveness of training programs in improving neonatal outcomes and emphasizes the cost-effectiveness of such interventions, highlighting the potential to save lives and ensure normal developmental outcomes for newborns.