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A rapid reduction in under-five mortality has put Bangladesh on-track to reach Millennium Development Goal 4. Little research, however, has been conducted into neonatal reductions and sub-national rates in the country, with considerable disparities potentially masked by national reductions. The aim of this paper is to estimate national and sub-national rates of neonatal mortality to compute relative and absolute inequalities between sub-national groups and draw comparisons with rates of under-five mortality. Mortality rates for under-five children and neonates were estimated directly for 1980-1981 to 2010-2011 using data from six waves of the Demographic and Health Survey. Rates were stratified by levels of rural/urban location, household wealth and maternal education. Absolute and relative inequalities within these groups were measured by rate differences and ratios, and where possible, slope and relative indices of inequality. National mortality was shown to have decreased dramatically although at differential rates for under-fives and neonates. Across all equity markers, a general pattern of declining absolute but constant relative inequalities was found. For mortality rates stratified by education and wealth mixed evidence suggests that relative inequalities may have also fallen. Although disparities remain, Bangladesh has achieved a rare combination of substantive reductions in mortality levels without increases in relative inequalities. A coalescence of substantial increases in coverage and equitable distribution of key child and neonatal interventions with widespread health sectoral and policy changes over the last 30 years may in part explain this exceptional pattern. Electronic supplementary material The online version of this article (doi:10.1007/s10995-015-1716-z) contains supplementary material, which is available to authorized users., Author(s): Mark Minnery[sup.1] , Sonja Firth[sup.1] , Andrew Hodge[sup.1] , Eliana Jimenez-Soto[sup.1] Author Affiliations: (1) Investment Case, School of Population Health, The University of Queensland, Public Health Building, Herston Road, [...]

Objective To predict the subnational spatial variation in the number of people infected with Schistosoma haematobium in Burkina Faso, Mali and the Niger prior to national control programmes. Methods We used field survey data sets covering a contiguous area 2750 x 850 km and including 26 790 school-age children (5-14 years old) in 418 schools. The prevalence of high- and low-intensity infection and associated 95% credible intervals (Crls) were predicted using Bayesian geostatistical models. The number infected was determined from the predicted prevalence and the number of school-age children in each [km.sup.2]. Findings The predicted number of school-age children with a low-intensity infection was 433 268 in Burkina Faso, 872 328 in Mali and 580 286 in the Niger. The number with a high-intensity infection was 416 009, 511 845 and 254 150 in each country, respectively. The 95% Crls were wide: e.g. the mean number of boys aged 10-14 years infected in Mali was 140 200 (95% Crl: 6200-512 100). Conclusion National aggregate estimates of infection mask important local variations: e.g. most S. haematobium infections in the Niger occur in the Niger River valley. High-intensity infection was strongly clustered in western and central Mali, north-eastern and north-western Burkina Faso and the Niger River valley in the Niger. Populations in these foci will carry the bulk of the urinary schistosomiasis burden and should be prioritized for schistosomiasis control. Uncertainties in the predicted prevalence and the numbers infected should be acknowledged by control programme planners. Objectif Predire les variations spatiales au niveau infranational du nombre de personnes infestees par Schistosoma haematobium au Burkina Faso, au Mali et au Niger, avant la mise en place des programmes nationaux de lutte contre la schistosomiase. Methodes Nous avons utilise un jeu de donnees d'enquete sur le terrain couvrant une zone contigue de 2750 x 850 km et 26 790 enfants d'age scolaire (5-14 ans), repartis dans 418 ecoles. La prevalence des schistosomiases de forte et de faible intensite, ainsi que les intervalles de credibilite a 95% associes, ont ete predits a l'aide de modeles geostatistiques bayesiens. Le nombre de personnes infestees a ete determine a partir de la prevalence predite et du nombre d'enfants d'age scolaire par [km.sup.2]. Resultats D'apres les predictions de l'etude, le nombre d'enfants d'age scolaire atteints d'une schistosomiase de faible intensite serait de 433 268 au Burkina Faso, de 872 328 au Mali et de 580 286 au Niger. S'agissant ales enfants fortement infestes, Ies predictions donnaient respectivement 416 009 cas pour le Burkina Faso, 511 845 pour le Mali et 254 150 pour le Niger. Les intervalles de credibilite a 95 % etaient larges: par exemple, le nombre moyen de garcons de 10 a 14 ans infestes au Mali etait de 140 200 (ICr a 95 %: 6200-512 100). Conclusion Les estimations nationales agregees masquent d'importantes variations locales: par exemple, la plupart des infestations par S. haematobium relevees au Niger etaient apparues dans la Vallee du Niger. Les cas d'infestation lourde etaient tres fortement regroupes a l'Ouest et au centre du Mali, au Nord-est et au Nord-ouest du Burkina Faso et dans la Vallee du Niger, au Niger. Les populations de ces foyers supportent la plus grande part de la charge de schistosomiase urinaire et doivent etre considerees comme prioritaires dans la lutte contre la schistosomiase. Les planificateurs de programmes de lutte contre cette maladie doivent etre conscients des incertitudes qui pesent sur les predictions de la prevalence et du nombre de personnes infestees. Objetivo Predecir la variacion territorial subnacional del numero de personas infectadas por Schistosoma haematobium en Burkina Faso, Mali y el Niger antes del inicio de los programas de control nacionales. Metodos Usamos conjuntos de datos de encuestas sobre el terreno que abarcaron en total a 26 790 ninos en edad escolar (5 a 14 anos) de 418 escuelas repartidos en una zona de 2750 x 850 km. Mediante modelos geoestadisticos bayesianos se predijeron la prevalencia de infeccion de alta y baja intensidad y los correspondientes intervalos de credibilidad (ICr) del 95%. El numero de personas infectadas se determino a partir de la prevalencia predicha y del numero de ninos en edad escolar por [km.sup.2]. Resultados Las predicciones sobre el numero de ninos en edad escolar con infeccion de baja intensidad fueron de 433 268 en Burkina Faso, 872 328 en Mali y 580 286 en el Niger. El numero de casos de infeccion de alta intensidad fue de 416 009, 511 845 y 254 150, respectivamente. Los ICr95% fueron amplios: p.ej., la media de muchachos de 10 a 14 anos infectados en Mali fue de 140 200 (ICr95%: 6200-512 100). Conclusion Las estimaciones totales nacionales de infeccion ocultan variaciones locales importantes: p.ej., en el Niger la mayoria de las infecciones por S. haematobium se dan en el valle del Rio Niger. La infeccion de alta intensidad se concentra marcadamente en el centro y oeste de Mali, las zonas nororiental y noroccidental de Burkina Faso y el valle del Rio Niger en el Niger. Las poblaciones de esos focos soportaran la mayor carga de esquistosomiasis urinaria y deberian ser un objetivo prioritario de la lucha contra la esquistosomiasis. Los planificadores de los programas de control deben tener en cuenta la incertidumbre asociada a la prevalencia predicha y las cifras de personas infectadas., Une traduction en francais de ce resume figure a la fin de l'article. Al final del articulo se facilita una traduccion al espanol. Introduction An accurate estimate of the proportion [...]

Abstract Background Responsibility for planning and delivery of health services in the Philippines is devolved to the local government level. Given the recognised need to strengthen capacity for local planning and budgeting, we implemented Investment Cases (IC) for Maternal, Neonatal and Child Health (MNCH) in three selected sub-national units: two poor, rural provinces and one highly-urbanised city. The IC combines structured problem-solving by local policymakers and planners to identify key health system constraints and strategies to scale-up critical MNCH interventions with a decision-support model to estimate the cost and impact of different scaling-up scenarios. Methods We outline how the initiative was implemented, the aspects that worked well, and the key limitations identified in the sub-national application of this approach. Results Local officials found the structured analysis of health system constraints helpful to identify problems and select locally appropriate strategies. In particular the process was an improvement on standard approaches that focused only on supply-side issues. However, the lack of data available at the local level is a major impediment to planning. While the majority of the strategies recommended by the IC were incorporated into the 2011 plans and budgets in the three study sites, one key strategy in the participating city was subsequently reversed in 2012. Higher level systemic issues are likely to have influenced use of evidence in plans and budgets and implementation of strategies. Conclusions Efforts should be made to improve locally-representative data through routine information systems for planning and monitoring purposes. Even with sound plans and budgets, evidence is only one factor influencing investments in health. Political considerations at a local level and issues related to decentralisation, influence prioritisation and implementation of plans. In addition to the strengthening of capacity at local level, a parallel process at a higher level of government to relieve fund channelling and coordination issues is critical for any evidence-based planning approach to have a significant impact on health service delivery.

Background: In Bangladesh, a poorly functioning national system of registering deaths and determining their causes leaves the country without important information on which to inform health programming, particularly for the 85% of deaths that occur in the community. In 2017, an improved death registration system and automated verbal autopsy (VA) were introduced to 13 upazilas to assess the utility of VA as a routine source of policy-relevant information and to identify leading causes of deaths (COD) in rural Bangladesh.Methods: Data from 22,535 VAs, collected in 12 upazilas between October 2017 and August 2019, were assigned a COD using the SmartVA Analyze 2.0 computer algorithm. The plausibility of the VA results was assessed using a series of demographic and epidemiological checks in the Verbal Autopsy Interpretation, Performance and Evaluation Resource (VIPER) software tool.Results: Completeness of community death reporting was 65%. The vast majority (85%) of adult deaths were due to non-communicable diseases, with ischemic heart disease, stroke and chronic respiratory disease comprising about 60% alone. Leading COD were broadly consistent with Global Burden of Disease study estimates.Conclusions: Routine VA collection using automated methods is feasible, can produce plausible results and provides critical information on community COD in Bangladesh. Routine VA and VIPER have potential application to countries with weak death registration systems. [ABSTRACT FROM AUTHOR]

Background Technically feasible and cost-effective interventions exist to reduce maternal, newborn, and child mortality [1,2]. This potential has not been fully realised due to the failure of health systems to [...]

Background: Health-related within-country inequalities continue to be a matter of great interest and concern to both policy makers and researchers. This study aims to assess the level and the distribution of child mortality outcomes in the Philippines across geographical and socioeconomic indicators. Methodology: Data on 159,130 children ever borne were analysed from five waves of the Philippine Demographic and Health Survey. Direct estimation was used to construct under-five and neonatal mortality rates for the period 1980–2013. Rate differences and ratios, and where possible, slope and relative indices of inequality were calculated to measure disparities on absolute and relative scales. Stratification was undertaken by levels of rural/urban location, island groups and household wealth. Findings: National under-five and neonatal mortality rates have shown considerable albeit differential reductions since 1980. Recently released data suggests that neonatal mortality has declined following a period of stagnation. Declines in under-five mortality have been accompanied by decreases in wealth and geography-related absolute inequalities. However, relative inequalities for the same markers have remained stable over time. For neonates, mixed evidence suggests that absolute and relative inequalities have remained stable or may have risen. Conclusion: In addition to continued reductions in under-five mortality, new data suggests that the Philippines have achieved success in addressing the commonly observed stagnated trend in neonatal mortality. This success has been driven by economic improvement since 2006 as well as efforts to implement a nationwide universal health care campaign. Yet, such patterns, nonetheless, accorded with persistent inequalities, particularly on a relative scale. A continued focus on addressing universal coverage, the influence of decentralisation and armed conflict, and issues along the continuum of care is advocated. [ABSTRACT FROM AUTHOR]

Background: India has the world's highest total number of under-five deaths of any nation. While progress towards Millennium Development Goal 4 has been documented at the state level, little information is available for greater disaggregation of child health markers within states. In 2000, new states were created within the country as a partial response to political pressures. State-level information on child health trends in the new states of Chhattisgarh and Jharkhand is scarce. To fill this gap, this article examines under-five and neonatal mortality across various equity markers within these two new states, pre-and post-split. Methods: Both direct and indirect estimation using pooled data from five available sources were undertaken. Inter-population disparities were evaluated by mortality data stratification of rural-urban location, ethnicity, wealth and districts. Results: Both states experienced an overall reduction in under-five and neonatal mortality, however, this has stagnated post-2001 and various disparities persist. In cases where disparities have declined, such as between urban-rural populations and low- and high-income groups, this has been driven by modest declines within the disadvantaged groups (i.e. low-income rural households) and stagnation or worsening of outcomes within the advantaged groups. Indeed, rising trends in mortality are most prevalent in urban middle-income households. Conclusions: The results suggest that rural health improvements may have come at the expense of urban areas, where poor performance may be attributed to factors such as lack of access to quality private health facilities. In addition, the disparities may in part be associated with geographical access, traditional practices and district-level health resource allocation. [ABSTRACT FROM AUTHOR]

Background: Without addressing the constraints specific to disadvantaged populations, national health policies such as universal health coverage risk increasing equity gaps. Health system constraints often have the greatest impact on disadvantaged populations, resulting in poor access to quality health services among vulnerable groups. Methods: The Investment Cases in Indonesia, Nepal, Philippines, and the state of Orissa in India were implemented to support evidence-based sub-national planning and budgeting for equitable scale-up of quality MNCH services. The Investment Case framework combines the basic setup of strategic problem solving with a decision-support model. The analysis and identification of strategies to scale-up priority MNCH interventions is conducted by in-country planners and policymakers with facilitation from local and international research partners. Results: Significant variation in scaling-up constraints, strategies, and associated costs were identified between countries and across urban and rural typologies. Community-based strategies have been considered for rural populations served predominantly by public providers, but this analysis suggests that the scaling-up of maternal, newborn, and child health services requires health system interventions focused on 'getting the basics right'. These include upgrading or building facilities, training and redistribution of staff, better supervision, and strengthening the procurement of essential commodities. Some of these strategies involve substantial early capital expenditure in remote and sparsely populated districts. These supply-side strategies are not only the 'best buys', but also the 'required buys' to ensure the quality of health services as coverage increases. By contrast, such public supply strategies may not be the 'best buys' in densely populated urbanised settings, served by a mix of public and private providers. Instead, robust regulatory and supervisory mechanisms are required to improve the accessibility and quality of services delivered by the private sector. They can lead to important maternal mortality reductions at relatively low costs. Conclusions: National strategies that do not take into consideration the special circumstances of disadvantaged areas risk disempowering local managers and may lead to a "business-as-usual" acceptance of unreachable goals. To effectively guide health service delivery at a local level, national plans should adopt typologies that reflect the different problems and strategies to scale up key MNCH interventions. [ABSTRACT FROM AUTHOR]