Dataset Information

Using LiST to model potential reduction in under-five mortality in Burkina Faso.

ABSTRACT:

Background

Under-five mortality remains high in Burkina Faso with significant reductions required to meet Millennium Development Goal 4. The Acceleration for Maternal, Newborn, and Child Health is being implemented to reduce child mortality in the North and Center North regions of Burkina Faso.

Methods

The Lives Saved Tool was used to determine the percent reduction in child mortality that can be achieved given baseline levels of coverage for interventions targeted by the Acceleration. Data were obtained from the Demographic and Health Survey 2003, the Multiple Indicator Cluster Survey 2006, and the baseline survey for the program from 2010. In addition to the scale up, scenarios were generated to examine the outcome if secular trends in intervention coverage change persisted and if intervention coverage levels remained constant.

Results

Scaling up all interventions to their target coverage level showed a potential reduction in under-five mortality of 22 percent, with district specific reductions in mortality ranging from 14 to 25 percent. The percent reduction in under-five mortality that might be attributable to the program was 16 percent and varied between 14 and 19 percent by district. Treatment of diarrhea with ORS and malaria with ACTs accounted for the majority of the reduction in mortality.

Conclusions

These findings suggest that significant reductions in under-five mortality may be achieved through the scale-up of the Acceleration. The Ministry of Health and its partners in Burkina Faso should continue their efforts to scale up these proven interventions to achieve and even exceed target levels for coverage.

SUBMITTER: Marsh A

PROVIDER: S-EPMC3847624 | biostudies-literature | 2013

REPOSITORIES: biostudies-literature

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Publications

Using LiST to model potential reduction in under-five mortality in Burkina Faso.

Marsh Andrew A Munos Melinda M Baya Banza B Sanon Djeneba D Gilroy Kate K Bryce Jennifer J

BMC public health 20130917

<h4>Background</h4>Under-five mortality remains high in Burkina Faso with significant reductions required to meet Millennium Development Goal 4. The Acceleration for Maternal, Newborn, and Child Health is being implemented to reduce child mortality in the North and Center North regions of Burkina Faso.<h4>Methods</h4>The Lives Saved Tool was used to determine the percent reduction in child mortality that can be achieved given baseline levels of coverage for interventions targeted by the Accelera ...[more]

PMID: 24564341

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Project description:BACKGROUND:Over the past 15 years, scaling up of cost effective interventions resulted in a remarkable decline of under-five mortality rates (U5MR) in sub-Saharan Africa. However, the reduction shows considerable heterogeneity. We estimated the association of child, maternal, and household interventions with U5MR in Burkina Faso at national and subnational levels and identified the regions with least effective interventions. METHODS:Data on health-related interventions and U5MR were extracted from the Burkina Faso Demographic and Health Survey (DHS) 2010. Bayesian geostatistical proportional hazards models with a Weibull baseline hazard were fitted on the mortality outcome. Spatially varying coefficients were considered to assess the geographical variation in the association of the health interventions with U5MR. The analyses were adjusted for child, maternal, and household characteristics, as well as climatic and environmental factors. FINDINGS:The average U5MR was as high as 128 per 1000 ranging from 81 (region of Centre-Est) to 223 (region of Sahel). At national level, DPT3 immunization and baby post-natal check within 24 hours after birth had the most important association with U5MR (hazard rates ratio (HRR) = 0.89, 95% Bayesian credible interval (BCI): 0.86-0.98 and HRR = 0.89, 95% BCI: 0.86-0.92, respectively). At sub-national level, the most effective interventions are the skilled birth attendance, and improved drinking water, followed by baby post-natal check within 24 hours after birth, vitamin A supplementation, antenatal care visit and all-antigens immunization (including BCG, Polio3, DPT3, and measles immunization). Centre-Est, Sahel, and Sud-Ouest were the regions with the highest number of effective interventions. There was no intervention that had a statistically important association with child survival in the region of Hauts Bassins. INTERPRETATION:The geographical variation in the magnitude and statistical importance of the association between health interventions and U5MR raises the need to deliver and reinforce health interventions at a more granular level. Priority interventions are DPT3 immunization, skilled birth attendance, baby post-natal visits in the regions of Sud-Ouest, Sahel, and Hauts Bassins, respectively. Our methodology could be applied to other national surveys, as it allows an incisive, data-driven and specific decision-making approach to optimize the allocation of health interventions at subnational level.

Project description:BackgroundDiarrhea is a leading cause of morbidity and mortality among children under five years of age. The Lives Saved Tool (LiST) is a model used to calculate deaths averted or lives saved by past interventions and for the purposes of program planning when costly and time consuming impact studies are not possible.DiscussionLiST models the relationship between coverage of interventions and outputs, such as stunting, diarrhea incidence and diarrhea mortality. Each intervention directly prevents a proportion of diarrhea deaths such that the effect size of the intervention is multiplied by coverage to calculate lives saved. That is, the maximum effect size could be achieved at 100% coverage, but at 50% coverage only 50% of possible deaths are prevented. Diarrhea mortality is one of the most complex causes of death to be modeled. The complexity is driven by the combination of direct prevention and treatment interventions as well as interventions that operate indirectly via the reduction in risk factors, such as stunting and wasting. Published evidence is used to quantify the effect sizes for each direct and indirect relationship. Several studies have compared measured changes in mortality to LiST estimates of mortality change looking at different sets of interventions in different countries. While comparison work has generally found good agreement between the LiST estimates and measured mortality reduction, where data availability is weak, the model is less likely to produce accurate results. LiST can be used as a component of program evaluation, but should be coupled with more complete information on inputs, processes and outputs, not just outcomes and impact.SummaryLiST is an effective tool for modeling diarrhea mortality and can be a useful alternative to large and expensive mortality impact studies. Predicting the impact of interventions or comparing the impact of more than one intervention without having to wait for the results of large and expensive mortality studies is critical to keep programs focused and results oriented for continued reductions in diarrhea and all-cause mortality among children under five years of age.

Project description:Background:A cluster randomised trial (CRT) in Burkina Faso was the first to demonstrate that a radio campaign increased health-seeking behaviours, specifically antenatal care attendance, health facility deliveries and primary care consultations for children under 5 years. Methods:Under-five consultation data by diagnosis was obtained from primary health facilities in trial clusters, from January 2011 to December 2014. Interrupted time-series analyses were conducted to assess the intervention effect by time period on under-five consultations for separate diagnosis categories that were targeted by the media campaign. The Lives Saved Tool was used to estimate the number of under-five lives saved and the per cent reduction in child mortality that might have resulted from increased health service utilisation. Scenarios were generated to estimate the effect of the intervention in the CRT study areas, as well as a national scale-up in Burkina Faso and future scale-up scenarios for national media campaigns in five African countries from 2018 to 2020. Results:Consultations for malaria symptoms increased by 56% in the first year (95%?CI 30% to 88%; p<0.001) of the campaign, 37% in the second year (95%?CI 12% to 69%; p=0.003) and 35% in the third year (95%?CI 9% to 67%; p=0.006) relative to the increase in the control arm. Consultations for lower respiratory infections increased by 39% in the first year of the campaign (95%?CI 22% to 58%; p<0.001), 25% in the second (95%?CI 5% to 49%; p=0.010) and 11% in the third year (95%?CI -20% to 54%; p=0.525). Diarrhoea consultations increased by 73% in the first year (95%?CI 42% to 110%; p<0.001), 60% in the second (95%?CI 12% to 129%; p=0.010) and 107% in the third year (95%?CI 43% to 200%; p<0.001). Consultations for other diagnoses that were not targeted by the radio campaign did not differ between intervention and control arms. The estimated reduction in under-five mortality attributable to the radio intervention was 9.7% in the first year (uncertainty range: 5.1%-15.1%), 5.7% in the second year and 5.5% in the third year. The estimated number of under-five lives saved in the intervention zones during the trial was 2967 (range: 1110-5741). If scaled up nationally, the estimated reduction in under-five mortality would have been similar (9.2% in year 1, 5.6% in year 2 and 5.5% in year 3), equating to 14?888 under-five lives saved (range: 4832-30 432). The estimated number of lives that could be saved by implementing national media campaigns in other low-income settings ranged from 7205 in Burundi to 21?443 in Mozambique. Conclusion:Evidence from a CRT shows that a child health radio campaign increased under-five consultations at primary health centres for malaria, pneumonia and diarrhoea (the leading causes of postneonatal child mortality in Burkina Faso) and resulted in an estimated 7.1% average reduction in under-five mortality per year. These findings suggest important reductions in under-five mortality can be achieved by mass media alone, particularly when conducted at national scale.

Dataset Information

Using LiST to model potential reduction in under-five mortality in Burkina Faso.

Background

Methods

Results

Conclusions

Publications

Using LiST to model potential reduction in under-five mortality in Burkina Faso.

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