Factors associated with the decline in under five diarrhea mortality in Tanzania from 1980-2015.
Ontology highlight
ABSTRACT: Background
Tanzania has made great progress in reducing diarrhea mortality in under- five children. We examined factors associated with the decline and projected the impact of scaling up interventions or reducing risk factors on diarrhea deaths.Methods
We reviewed economic, health, and diarrhea-related policies, reports and programs implemented during 1980 to 2015. We used the Lives Saved Tool to determine the percentage reduction in diarrhea-specific mortality attributable to changes in coverage of the interventions and risk factors, including direct diarrhea-related interventions, nutrition, and water, sanitation and hygiene (WASH). We projected the number of diarrhea deaths that could be prevented in 2030, assuming near universal coverage of different intervention packages.Results
Diarrhea-specific mortality among under-five children in Tanzania declined by 89% from 35.3 deaths per 1000 live births in 1980 to 3.9 deaths per 1000 live births in 2015. Factors associated with diarrhea-specific under-five mortality reduction included oral rehydration solution (ORS) use, changes in stunting prevalence, vitamin A supplementation, rotavirus vaccine, change in wasting prevalence and change in age-appropriate breastfeeding practices. Universal coverage of direct diarrhea, nutrition and WASH interventions has the potential reduce the diarrhea-specific mortality rate by 90%.Conclusions
Scaling up of a few key childhood interventions such as ORS and nutrition, and reducing the prevalence of stunting would address the remaining diarrhea-specific under-five mortality by 2030.
SUBMITTER: Masanja H
PROVIDER: S-EPMC6816318 | biostudies-literature | 2019 Dec
REPOSITORIES: biostudies-literature
Publications
Factors associated with the decline in under five diarrhea mortality in Tanzania from 1980-2015.
Masanja Honorati H Mongi Pyande P Baraka Jitihada J Jackson Bianca B Kisisiwe Yasinta Y Manji Karim K Iriya Nemes N John Theopista T Kimatta Said S Walker Neff N Black Robert E RE
Journal of global health 20191201 2
<h4>Background</h4>Tanzania has made great progress in reducing diarrhea mortality in under- five children. We examined factors associated with the decline and projected the impact of scaling up interventions or reducing risk factors on diarrhea deaths.<h4>Methods</h4>We reviewed economic, health, and diarrhea-related policies, reports and programs implemented during 1980 to 2015. We used the Lives Saved Tool to determine the percentage reduction in diarrhea-specific mortality attributable to ch ...[more]
Similar Datasets
Project description:Background:India has achieved 86% reduction in the number of under-five diarrheal deaths from 1980 to 2015. Nonetheless diarrhea is still among the leading causes of under-five deaths. The aim of this analysis was to study the contribution of factors that led to decline in diarrheal deaths in the country and the effect of scaling up of intervention packages to address the remaining diarrheal deaths. Methods:We assessed the attribution of different factors and intervention packages such as direct diarrhea case management interventions, nutritional factors and WASH interventions which contributed to diarrhea specific under-five mortality reduction (DSMR) during 1980 to 2015 using the Lives Saved Tool (LiST). The potential impact of scaling up different packages of interventions to achieve universal coverage levels by year 2030 on reducing the number of remaining diarrheal deaths were estimated. Results:The major factors associated with DSMR reduction in under-fives during 1980 to 2015, were increase in ORS use, reduction in stunting prevalence, improved sanitation, changes in age appropriate breastfeeding practices, increase in the vitamin-A supplementation and persistent diarrhea treatment. ORS use and reduction in stunting were the two key interventions, each accounting for around 32% of the lives saved during this period. Scaling up the direct diarrhea case management interventions from the current coverage levels in 2015 to achieve universal coverage levels by 2030 can save around 82?000 additional lives. If the universal targets for nutritional factors and WASH interventions can be achieved, an additional 23?675 lives can potentially be saved. Conclusions:While it is crucial to improve the coverage and equity in ORS use, an integrated approach to promote nutrition, WASH and direct diarrhea interventions is likely to yield the highest impact on reducing the remaining diarrheal deaths in under-five children.
| S-EPMC6816285 | biostudies-literature
Project description:BackgroundUnder-five mortality refers to the likelihood of dying between the ages of birth and five. The number of children under the age of five who die each year continues to climb worldwide. Over the previous few decades, the industry has made great progress in reducing mortality among children under the age of five. The study aims to identify the factors associated with under-five mortality in Ethiopia.Subject and methodCommunity-based Cross-sectional data came from Ethiopia's Mini Demographic and Health Survey 2019. In two stages, the 2019 EMDHS sample was stratified and selected. 8855 women of reproductive age were interviewed using a nationally representative Woman (ages 15 to 49) and 5753 children were included. Ethiopia's under-five mortality served as the study's dependent (response) or outcome variable. Binary logistic regression was used to see if there is an association between the dependent and independent variables. All variables with a p-value of less than 0.25 in the bivariate analysis were chosen for the multivariable logistic regression to compensate for putative confounders. Significant predictors were defined as factors with a p-value of less than 0.05.ResultsA total of 5753 under-5 mortality were enrolled in this study. 339 (5.9%) of under-five Mortality have been declared lifeless before reaching the age of five. There were 1328(23.1%) and 4425(76.1%) with 72 (5.42%) and 267 (6.02%) of under-five mortality occurring in urban and rural respectively. Under-five mortality in the Afar region was 2.280 times more likely Compared to Children born in Tigray Region (AOR = 2.280 95% CI = 1.137-4.568, P = .020). Under-five Mortality in Rural residences was 1.908 times more likely as Compared to Urban Residence (AOR = 1.908, 95% CI = 1.257-4.539, P = .035). Under-five mortality in Poorer index Households was 0.343 times Less likely as compared to children born in the poorest index Household (AOR = 0.343,95% CI = 0.128-0.910, P = ). Under-five mortality in the public sector was 1.763 times less likely than among children born at Home (AOR = 1.763, 95% CI = 1.252-2.482, P = .033). Under-five Mortality of second multiple births was 2.389 times more likely Compared to Single birth (AOR = 2.389, 95% CI = 1.257-4.539, P = .008).ConclusionThis study found that the prevalence of under-five mortality, is 5.9% (59/1000) or 59 death per one thousand live children in Ethiopia. The under-five mortality rate is rapidly declining, and access to and utilization of health care is improving. Region, residence, level of education, wealth index, Place of Delivery and multiple births have all been statistically significant factors of under-five mortality in Ethiopia. The government and all stockholders should be given attention to maternal and infant health care to reduce under-five mortality.
| S-EPMC9289410 | biostudies-literature
Project description:BackgroundIn the year 2019, around 5 million children under age five died and most of the deaths happened in developing countries. Though large numbers of deaths are reported in such countries, limited availability of data poses a substantial challenge on generating reliable estimates. Hence, this study aims to assess the prevalence and factors associated with under-five mortality in southeastern Ethiopia.MethodsA register based cross sectional study was conducted from 1st September 2014 to July 2019 in Asella teaching and referral hospital. A total of 4901 under-five age children registered on the admission and discharge book of pediatric ward with complete information were included for the analysis. Data entry and analysis were conducted using Epidata Version 7 and SPSS version 21, respectively. Descriptive statistics were used to explore the characteristics of the study participants and their condition at discharge. Adjusted Odds Ratio (AOR) with its 95% Confidence interval and P-value less than 5% was used to decide the statistically significant association.ResultsThe prevalence of under-five mortality among admitted children in Asella Teaching and Referral hospital was 8.7% (95% CI 7.91-9.50%). Post-Neonatal and Child mortality were found to be 9.1% and 8.18%, respectively. Moreover, large numbers of death (45.2%) were seen within the first 2 days of admission. Address (AOR:1.4(1.08-1.81)), HIV status (AOR:4.64 (2.19-9.8)), severe acute malnutrition (AOR:2.82 (2.03-3.91)), hypovolemic shock (AOR:4.32 (2.31-8.1)), type I diabetes with DKA (AOR:3.53(1.34-9.29) and length of stay in the hospital for ≤2 days (AOR: 4.28 (3.09-5.95)) as well as 3-4 days (AOR: 1.48 (1.02-2.15)) were among the identified predictors.ConclusionsThough childhood mortality is swiftly decreasing, and access and utilization of health care is improving in Ethiopia, our study found large prevalence of under-five mortality, 8.7% and higher number of deaths in early days of admission. Improving the quality of service has a paramount importance in reducing the mortality and managing associated factors contributing to under-five mortality among admitted children.
| S-EPMC8423275 | biostudies-literature
Project description:BackgroundChildhood diarrhea deaths have declined more than 80% from 1980 to 2015, in spite of an increase in the number of children in low- and middle-income countries (LMIC). Possible drivers of this remarkable accomplishment can guide the further reduction of the half million annual child deaths from diarrhea that still occur.MethodsWe used the Lives Saved Tool, which models effects on mortality due to changes in coverage of preventive or therapeutic interventions or risk factors, for 50 LMIC to determine the proximal drivers of the diarrhea mortality reduction.ResultsDiarrhea treatment (oral rehydration solution [ORS], zinc, antibiotics for dysentery and management of persistent diarrhea) and use of rotavirus vaccine accounted for 49.7% of the diarrhea mortality reduction from 1980 to 2015. Improvements in nutrition (stunting, wasting, breastfeeding practices, vitamin A) accounted for 38.8% and improvements in water, sanitation and handwashing for 11.5%. The contribution of ORS was greater from 1980 to 2000 (58.0% of the reduction) than from 2000 to 2015 (30.7%); coverage of ORS increased from zero in 1980 to 29.5% in 2000 and more slowly to 44.1% by 2015. To eliminate the remaining childhood diarrhea deaths globally, all these interventions will be needed. Scaling up diarrhea treatment and rotavirus vaccine, to 90% coverage could reduce global child diarrhea mortality by 74.1% from 2015 levels by 2030. Adding improved nutrition could increase that to 89.1%. Finally, adding increased use of improved water sources, sanitation and handwashing could result in a 92.8% reduction from the 2015 level.ConclusionsEmploying the interventions that have resulted in such a large reduction in diarrhea mortality in the last 35 years can virtually eliminate remaining childhood diarrhea deaths by 2030.
| S-EPMC6815873 | biostudies-literature
Project description:BackgroundPreventing the life of the newborn and reducing the entrenched disparity of childhood mortality across different levels is one of the crucial public health problems, especially in underdeveloped and developing countries in the world. Sustainable development goals (SDGs)-3.2 is aimed at terminating all preventable under-five child mortality and shrinking it to 25 per 1000 live births or lower than this by 2030. Several factors have been shown to be linked with childhood mortality.ObjectiveThis review is aimed at pointing out the significant determinants related to under-five child mortality by a systematic review of the literature.MethodsEMBASE, PubMed, Scopus database, and Google Scholar search engine were used for the systematic search of the literature. Special keywords and Boolean operators were used to point out the relevant studies for the review. Original research articles and peer-reviewed papers published in the English language till August 10, 2022, were included in the analysis and synthesis of the results. As per the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines, out of 299 studies identified from different sources, only 22 articles were ascertained for this study. Eligible articles were appraised in detail, and relevant information was extracted and then integrated into the systematic review.ResultsMother's education, size of child at birth, age of mother at childbirth, place of residence, birth interval, sex of child, type of birth (single or multiple), and birth order, along with other socioeconomic, maternal, child, health facility utilization, and community level variables, were observed as important covariates of under-five mortality.ConclusionWomen's education and easy access to quality healthcare facilities should be the apex priority to lessen childhood mortality.
| S-EPMC9744612 | biostudies-literature
Project description:BackgroundDiarrheal disease is still one of the most common causes of mortality and morbidity in children under five in developing countries, including Ethiopia. Lack of specific data on the prevalence of acute diarrhea and associated factors among under-five children in the semi-urban areas of Gelsha, found in northeastern Ethiopia's South Wollo zone, remains a major gap. Therefore, this study was designed to provide data that is important for proper planning of intervention measures to reduce the problem in this area.MethodsA community-based cross-sectional study was conducted among 340 systematically selected children under five in semi-urban areas of Gelsha from January to March 2019. The data was collected using a structured questionnaire and an observational checklist. Bivariable (crude odds ratio [COR]) and multivariable analysis (adjusted odds ratio [AOR]) were employed using binary logistic regression model with 95% CI (confidence interval). Variables with a p-value < 0.05 from the multivariable analysis were declared as factors significantly associated with acute diarrhea.ResultThe prevalence of acute diarrhea among children under five in the study area was 11% (95%CI: 7.8-14.3%). About two-thirds (63.60%) of study participants used water from improved sources. About half (54.90%) of study participants practiced poor handwashing and 45.10% practiced good handwashing. We found that factors significantly associated with acute diarrhea were a child's age of 12-23 months (AOR = 4.68, 95% CI: 1.45-1.50), the presence of two or more under-five children in the house (AOR = 2.84, 95% CI: 1.19-6.81), unimproved water sources (AOR = 2.97, 95% CI: 1.28-6.87) and presence of feces around the pit hole/slab/floor of the latrine (AOR = 3.34, 95% CI: 1.34-8.31).ConclusionThe prevalence of acute diarrhea among children under five was relatively high. To reduce the problem, various prevention strategies are essential, such as the provision of health education to mothers/caregivers that focuses on keeping sanitation facilities clean and child care, and construction of improved water sources. Furthermore, implementing a strong health extension program, advocating an open defecation-free environment, and practicing a community-led total sanitation and hygiene approach might be helpful to sustainably reduce childhood diarrhea.
| S-EPMC8235618 | biostudies-literature
Project description:Child mortality in Nepal has reduced, but the rate is still above the Sustainable Development Goal target of 20 deaths per 1000 live births. This study aimed to identify common factors associated with under-five mortality in Nepal. Survival information of 16,802 most recent singleton live births from the Nepal Demographic and Health Survey for the period (2001⁻2016) were utilized. Survey-based Cox proportional hazard models were used to examine factors associated with under-five mortality. Multivariable analyses revealed the most common factors associated with mortality across all age subgroups included: mothers who reported previous death of a child [adjusted hazard ratio (aHR) 17.33, 95% confidence interval (CI) 11.44, 26.26 for neonatal; aHR 13.05, 95% CI 7.19, 23.67 for post-neonatal; aHR 15.90, 95% CI 11.38, 22.22 for infant; aHR 16.98, 95% CI 6.19, 46.58 for child; and aHR 15.97, 95% CI 11.64, 21.92 for under-five mortality]; nonuse of tetanus toxoids (TT) vaccinations during pregnancy (aHR 2.28, 95% CI 1.68, 3.09 for neonatal; aHR 1.86, 95% CI 1.24, 2.79 for post-neonatal; aHR 2.44, 95% CI 1.89, 3.15 for infant; aHR 2.93, 95% CI 1.51, 5.69 for child; and aHR 2.39, 95% CI 1.89, 3.01 for under-five mortality); and nonuse of contraceptives among mothers (aHR 1.69, 95% CI 1.21, 2.37 for neonatal; aHR 2.69, 95% CI 1.67, 4.32 for post-neonatal; aHR 2.01, 95% CI 1.53, 2.64 for infant; aHR 2.47, 95% CI 1.30, 4.71 for child; and aHR 2.03, 95% CI 1.57, 2.62 for under-five mortality). Family planning intervention as well as promotion of universal coverage of at least two doses of TT vaccine are essential to help achieve child survival Sustainable Development Goal (SDG) targets of <20 under-five deaths and <12 neonatal deaths per 1000 births by the year 2030.
| S-EPMC6479835 | biostudies-literature
Project description:BACKGROUND:Diarrhea is responsible for 525,000 children under-five deaths and 1.7 billion cases globally and is the second leading cause of death among children under-five every year. It is a major public health problem in low income countries like Ethiopia. The main aim of this study was to assess the prevalence of diarrhea and associated risk factors among children under-five in Debre Berhan Town, Ethiopia. METHODS:A community-based cross-sectional study was conducted in 420 parent or caretaker/children pairs in Debre Berhan town between 13 and 18 April 2018. A multi-stage sampling strategy was used to select the study participants. Data were collected using pre-tested and structured questionnaires. Data were entered in Epi-info computer software version 3.5.1 and exported to SPSS Window Version-16 for analysis. Adjusted odds ratio with 95% confidence intervals were used to assess the level of significance. RESULTS:The two week prevalence of diarrhea among children under-five was 16.4% (69/351). Children aged 7-11 months (adjusted odds ratio (AOR): 4.2, 95% confidence interval (CI): 1.2-15.3), being the second-born child (AOR: 3.9, 95%CI: 1.8-8.5), not vaccinated against rotavirus (AOR: 10.3, 95%CI: 3.2-91.3) and feeding children by hand (AOR: 2.5, 95%CI: 1.1-6.1) were significant predictors of diarrhea. CONCLUSIONS:This study revealed that the two weeks period prevalence of diarrhea among children under-five years was 16.4%. Education programs on the importance of vaccination against rotavirus, increasing breast feeding frequency with complementary food after six months and the critical points of hand washing are recommended.
| S-EPMC7041267 | biostudies-literature
Project description:BackgroundWorldwide, diarrhea is the second most common cause of death and morbidity among under -five years' children. In sub-saran Africa, access to water, sanitation, and hygiene are very scanty and the burden of diarrhea diseases is countless relative to the rest of the world. Prior studies conducted in East Africa vary in design, sample size, and other data collection tools. Through those studies, it is hard to make regional comparisons. Combining datasets that are studied on similar people and having common variable identified enhances statistical power due to the large sample size, advance the ability to compare outcomes, and create the opportunity to develop new indicators. Hence, this study aimed to assess the prevalence and associated factors of diarrhea among under five years' children using the most recent national representative Demographic and Health Surveys from 12 East African countries. The information generated from this pooled datasets will give good insight into the sub-regional prevalence of diarrhea.MethodsThis study utilized secondary data from 12 East African countries' most recent demographic health survey. Variables were extracted and appended together to assess the pooled prevalence of diarrhea and associated factors. A total of 90,263 under-five years of age children were encompassed in this study. STATA version was used to cross-tabulate and fit the models. To account for the hierarchical nature of the demographic health survey, multilevel logistic regression was calibrated. BIC, AIC, deviance, and LLR were used as Model comparison parameters. Variables with a p-value of <0.2 were considered for multivariable analysis. Adjusted odds ratio with 95% CI and p-value <0.05 were used to declare statistical significances of factors.ResultsThe pooled prevalence of diarrhea in under five years children was 14.28% [95%CI; 14.06%, 14.51%]. Being child whose mother age is 15-24 years [AOR = 1.41, 95% CI; 1.33, 1.49], 25-34 years[AOR = 1.17, 95%CI; 1.10, 1.23], being 7-12 months child [AOR = 3.10, 95%CI; 2.86, 3.35], being 12-24 months child [AOR = 2.56, 95%CI; 2.38, 3.75], being 25-59 months child [AOR = 0.88, 95%CI; 0.82, 0.95], being child from poor household [AOR = 1.16, 95%CI; 1.09, 1.23], delayed breast feeding initiation (initiated after an hour of birth) [AOR = 1.15, 95%CI; 1.10, 1.20], and being a child from community with low educational status [AOR = 1.10, 95%CI; 1.03, 1.18] were factors associated with diarrheal diseases.ConclusionThe pooled prevalence of diarrhea among under five years of children in East African countries is high. Maternal age, child's age, wealth status of the household, the timing of breast feeding initiation, sex of the child, community level of educational status, working status of the mother, and the number of under five children were factors that were associated with diarrheal diseases. Scaling up of maternal and child health services by government and other concerned bodies should consider those economically marginalized communities. Additionally, awareness should be created for those uneducated mothers concerning the nature of childhood diarrhea.
| S-EPMC9009646 | biostudies-literature
Project description:ImportanceCardiovascular (CV) mortality has declined for more than 3 decades in the US. However, differences in declines among residents at a US county level are not well characterized.ObjectiveTo identify unique county-level trajectories of CV mortality in the US during a 35-year study period and explore county-level factors that are associated with CV mortality trajectories.Design, setting, and participantsThis longitudinal cross-sectional analysis of CV mortality trends used data from 3133 US counties from 1980 to 2014. County-level demographic, socioeconomic, environmental, and health-related risk factors were compiled. Data were analyzed from December 2019 to September 2021.ExposuresCounty-level characteristics, collected from 5 county-level data sets.Main outcomes and measuresCardiovascular mortality data were obtained for 3133 US counties from 1980 to 2014 using age-standardized county-level mortality rates from the Global Burden of Disease study. The longitudinal K-means approach was used to identify 3 distinct clusters based on underlying mortality trajectory. Multinomial logistic regression models were constructed to evaluate associations between county characteristics and cluster membership.ResultsAmong 3133 US counties (median, 49.5% [IQR, 48.9%-50.5%] men; 30.7% [IQR, 27.1%-34.4%] older than 55 years; 9.9% [IQR, 4.5%-22.7%] racial minority group [individuals self-identifying as Black or African American, American Indian or Alaska Native, Asian, Native Hawaiian, Pacific Islander, other, or multiple races/ethnicities]), CV mortality declined by 45.5% overall and by 38.4% in high-mortality strata (694 counties), by 45.0% in intermediate-mortality strata (1382 counties), and by 48.3% in low-mortality strata (1057 counties). Counties with the highest mortality in 1980 continued to demonstrate the highest mortality in 2014. Trajectory groups were regionally distributed, with high-mortality trajectory counties focused in the South and in portions of Appalachia. Low- vs high-mortality groups varied significantly in demographic (racial minority group proportion, 7.6% [IQR, 4.1%-14.5%]) vs 23.9% [IQR, 6.5%-40.8%]) and socioeconomic characteristics such as high-school education (9.4% [IQR, 7.3%-12.6%] vs 20.1% [IQR, 16.1%-23.2%]), poverty rates (11.4% [IQR, 8.8%-14.6%] vs 20.6% [IQR, 17.1%-24.4%]), and violent crime rates (161.5 [IQR, 89.0-262.4] vs 272.8 [IQR, 155.3-431.3] per 100 000 population). In multinomial logistic regression, a model incorporating demographic, socioeconomic, environmental, and health characteristics accounted for 60% of the variance in the CV mortality trajectory (R2 = 0.60). Sociodemographic factors such as racial minority group proportion (odds ratio [OR], 1.70 [95% CI, 1.35-2.14]) and educational attainment (OR, 6.17 [95% CI, 4.55-8.36]) and health behaviors such as smoking (OR for high vs low, 2.04 [95% CI, 1.58-2.64]) and physical inactivity (OR, 3.74 [95% CI, 2.83-4.93]) were associated with the high-mortality trajectory.Conclusions and relevanceCardiovascular mortality declined in all subgroups during the 35-year study period; however, disparities remained unchanged during that time. Disparate trajectories were associated with social and behavioral risks. Health policy efforts across multiple domains, including structural and public health targets, may be needed to reduce existing county-level cardiovascular mortality disparities.
| S-EPMC8634057 | biostudies-literature