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Associations between key intervention coverage and child mortality : an analysis of 241 sub-national regions of sub-Saharan Africa
JournalArticle (Originalarbeit in einer wissenschaftlichen Zeitschrift)
 
ID 4493762
Author(s) Akachi, Yoko; Steenland, Maria; Fink, Günther
Author(s) at UniBasel Fink, Günther
Year 2018
Title Associations between key intervention coverage and child mortality : an analysis of 241 sub-national regions of sub-Saharan Africa
Journal International journal of epidemiology
Volume 47
Number 3
Pages / Article-Number 740-751
Abstract Reducing child mortality remains a key objective in the Sustainable Development Goals. Although remarkable progress has been made with respect to under-5 mortality over the last 25 years, little is known regarding the relative contributions of public health interventions and general improvements in socioeconomic status during this time period.; We combined all available data from the Demographic and Health Survey (DHS) to construct a longitudinal, multi-level dataset with information on subnational-level key intervention coverage, household socioeconomic status and child health outcomes in sub-Saharan Africa. The dataset covers 562 896 child records and 769 region-year observations across 24 countries. We used multi-level multivariable logistics regression models to assess the associations between child mortality and changes in the coverage of 17 key reproductive, maternal, newborn and child health interventions such as bednets, water and sanitation infrastructure, vaccination and breastfeeding practices, as well as concurrent improvements in social and economic development.; Full vaccination coverage was associated with a 30% decrease in the odds of child mortality [odds ratio (OR) 0.698, 95% confidence interval (CI) 0.564, 0.864], and continued breastfeeding was associated with a 24% decrease in the odds of child mortality (OR 0.759, 95% CI 0.642, 0.898). Our results suggest that changes in vaccination coverage, as well as increases in female education and economic development, made the largest contributions to the positive mortality trends observed. Breastfeeding was associated with child survival but accounts for little of the observed declines in mortality due to declining coverage levels during our study period.; Our findings suggest that a large amount of progress has been made with respect to coverage levels of key health interventions. Whereas all socioeconomic variables considered appear to strongly predict health outcomes, the same was true only for very few health coverage indicators.
Publisher Oxford University Press
ISSN/ISBN 0300-5771
edoc-URL https://edoc.unibas.ch/68152/
Full Text on edoc No
Digital Object Identifier DOI 10.1093/ije/dyx262
PubMed ID http://www.ncbi.nlm.nih.gov/pubmed/29309582
ISI-Number WOS:000438342200013
Document type (ISI) Journal Article
 
   

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