From 1990-2010, worldwide child mortality declined by 43%, and maternal mortality declined by 40%. This paper compares two sources of progress: improvements in societal coverage of health ...determinants versus improvements in the impact of health determinants as a result of technical change.
This paper decomposes the progress made by 146 low- and middle-income countries (LMICs) in lowering childhood and maternal mortality into one component due to better health determinants like literacy, income, and health coverage and a second component due to changes in the impact of these health determinants. Health determinants were selected from eight distinct health-impacting sectors. Health determinants were selected from eight distinct health-impacting sectors. Regression models are used to estimate impact size in 1990 and again in 2010. Changes in the levels of health determinants were measured using secondary data.
The model shows that respectively 100% and 89% of the reductions in maternal and child mortality since 1990 were due to improvements in nationwide coverage of health determinants. The relative share of overall improvement attributable to any single determinant varies by country and by model specification. However, in aggregate, approximately 50% of the mortality reductions were due to improvements in the health sector, and the other 50% of the mortality reductions were due to gains outside the health sector.
Overall, countries improved maternal and child health (MCH) from 1990 to 2010 mainly through improvements in the societal coverage of a broad array of health system, social, economic and environmental determinants of child health. These findings vindicate efforts by the global community to obtain such improvements, and align with the post-2015 development agenda that builds on the lessons from the MDGs and highlights the importance of promoting health and sustainable development in a more integrated manner across sectors.
In low- and middle-income countries (LMICs), economic downturns can lead to increased child mortality by affecting dietary, environmental, and care-seeking factors. This study estimates the potential ...loss of life in children under five years old attributable to economic downturns in 2020. We used a multi-level, mixed effects model to estimate the relationship between gross domestic product (GDP) per capita and under-5 mortality rates (U5MRs) specific to each of 129 LMICs. Public data were retrieved from the World Bank World Development Indicators database and the United Nations World Populations Prospects estimates for the years 1990-2020. Country-specific regression coefficients on the relationship between child mortality and GDP were used to estimate the impact on U5MR of reductions in GDP per capita of 5%, 10%, and 15%. A 5% reduction in GDP per capita in 2020 was estimated to cause an additional 282,996 deaths in children under 5 in 2020. At 10% and 15%, recessions led to higher losses of under-5 lives, increasing to 585,802 and 911,026 additional deaths, respectively. Nearly half of all the potential under-5 lives lost in LMICs were estimated to occur in Sub-Saharan Africa. Because most of these deaths will likely be due to nutrition and environmental factors amenable to intervention, countries should ensure continued investments in food supplementation, growth monitoring, and comprehensive primary health care to mitigate potential burdens.
The growing interest in incorporating prevention into emergency health care make it timely to examine the use of computer technology to efficiently deliver effective education in this setting.
This ...RCT compared results from an intervention group (n=367) that received child passenger safety information, to an attention-matched control (n=375). A baseline survey and two follow-up surveys at 3 and 6 months were conducted.
Data were collected from June 2014 to September 2016 from a sample of parents with children aged 4–7 years recruited from a pediatric emergency department in an East Coast urban area and one in a Midwest semi-rural area.
A theory-based, stage-tailored educational program, Safety in Seconds v2.0TM, delivered on a mobile app.
Four car seat behaviors: (1) having the correct restraint for the child’s age and weight; (2) having the child ride in the backseat all the time; (3) buckling up the child all the time; and (4) having the child’s restraint inspected by a child passenger safety technician.
At 3 months, adjusting for baseline behaviors and attrition, the odds of reporting the correct behavior by the intervention group relative to the control group was 2.07 (p<0.01) for using the correct car seat; 2.37 (p<0.05) times for having the child ride in the back seat; 1.04 (nonsignificant) for riding buckled up all the time; and 1.99 (p<0.01) times for having the car seat inspected. At 6 months, there were statistically significant effects for reporting use of the correct car seat (OR=1.84, p<0.01) and having the car seat inspected (OR=1.73, p<0.01).
Mobile apps hold promise for reaching large populations with individually tailored child passenger safety education.
Clinical Trial Registration # NCT02345941.
Prior infection with one strain TB has been linked with diminished likelihood of re-infection by a new strain. This paper attempts to determine the role of declining prevalence of drug-susceptible TB ...in enabling future epidemics of MDR-TB.
A computer simulation of MDR-TB epidemics was developed using an agent-based model platform programmed in NetLogo (See http://mdr.tbtools.org/). Eighty-one scenarios were created, varying levels of treatment quality, diagnostic accuracy, microbial fitness cost, and the degree of immunogenicity elicited by drug-susceptible TB. Outcome measures were the number of independent MDR-TB cases per trial and the proportion of trials resulting in MDR-TB epidemics for a 500 year period after drug therapy for TB is introduced.
MDR-TB epidemics propagated more extensively after TB prevalence had fallen. At a case detection rate of 75%, improving therapeutic compliance from 50% to 75% can reduce the probability of an epidemic from 45% to 15%. Paradoxically, improving the case-detection rate from 50% to 75% when compliance with DOT is constant at 75% increases the probability of MDR-TB epidemics from 3% to 45%.
The ability of MDR-TB to spread depends on the prevalence of drug-susceptible TB. Immunologic protection conferred by exposure to drug-susceptible TB can be a crucial factor that prevents MDR-TB epidemics when TB treatment is poor. Any single population that successfully reduces its burden of drug-susceptible TB will have reduced herd immunity to externally or internally introduced strains of MDR-TB and can experience heightened vulnerability to an epidemic. Since countries with good TB control may be more vulnerable, their self interest dictates greater promotion of case detection and DOTS implementation in countries with poor control to control their risk of MDR-TB.
Highlights • Estimated incremental cost of an intervention in slums that increased vaccination coverage to 99%. • Intervention cost US$20.95 per fully immunized child, primarily due to supervision ...costs. • Extended hours and informal trainings most important components of intervention. • Reaching children in slums for eradication efforts may be more expensive than currently estimated.
In contexts with severe physician shortages, the World Health Organization advocates task shifting to cadres with shorter training. To investigate the effects of task shifting at scale in primary ...health care, we assessed the clinical knowledge of non-physician clinicians versus physicians working in public primary care facilities in Nigeria.
We assessed 4138 health workers using clinical vignettes of hypothetical patients suffering from illnesses commonly seen in primary care. Facility-level fixed effects models were used to compare health worker knowledge of (i) consultation guidelines, (ii) diagnostic accuracy and (iii) treatment guidelines.
Unadjusted averages of overall health worker knowledge were low across all types of worker except medical officers. After adjustment for potential confounding, the differences across all three measures between cadres became small or statistically insignificant.
Non-physician clinicians can provide the same quality of primary care, for a set of common illnesses, as Medical Officers with similar personal characteristics, but clinical skills across cadres need strengthening.
•Successful implementation of Korean strategy required more than actions, measures and policies.•It owes tremendously to legal and organizational reforms enacted after MERS.•It relied on pre-existing ...financing arrangements, governance and workforces experienced in outbreak.•Public’s response, including its solidarity and resilience, are key ingredients to success.
South Korea’s COVID-19 control strategy has been widely emulated. Korea’s ability to rapidly achieve disease control in early 2020 without a “Great Lockdown” despite its proximity to China and high population density make its achievement particularly intriguing. This paper helps explain Korea’s pre-existing capabilities which enabled the rapid and effective implementation of its COVID-19 control strategies. A systematic assessment across multiple domains demonstrates that South Korea’s advantages in controlling its epidemic are owed tremendously to legal and organizational reforms enacted after the MERS outbreak in 2015. Successful implementation of the Korean strategy required more than just a set of actions, measures and policies. It relied on a pre-existing legal framework, financing arrangements, governance and a workforce experienced in outbreak management.
Abstract Purpose Differences in neurocognitive functioning may contribute to driving performance among young drivers. However, few studies have examined this relation. This pilot study investigated ...whether common neurocognitive measures were associated with driving performance among young drivers in a driving simulator. Methods Young drivers (19.8 years (standard deviation SD = 1.9; N = 74)) participated in a battery of neurocognitive assessments measuring general intellectual capacity (Full-Scale Intelligence Quotient, FSIQ) and executive functioning, including the Stroop Color-Word Test (cognitive inhibition), Wisconsin Card Sort Test-64 (cognitive flexibility), and Attention Network Task (alerting, orienting, and executive attention). Participants then drove in a simulated vehicle under two conditions—a baseline and driving challenge. During the driving challenge, participants completed a verbal working memory task to increase demand on executive attention. Multiple regression models were used to evaluate the relations between the neurocognitive measures and driving performance under the two conditions. Results FSIQ, cognitive inhibition, and alerting were associated with better driving performance at baseline. FSIQ and cognitive inhibition were also associated with better driving performance during the verbal challenge. Measures of cognitive flexibility, orienting, and conflict executive control were not associated with driving performance under either condition. Conclusions FSIQ and, to some extent, measures of executive function are associated with driving performance in a driving simulator. Further research is needed to determine if executive function is associated with more advanced driving performance under conditions that demand greater cognitive load.
In the absence of adequate social security, out-of-pocket health expenditure compels households to adopt coping strategies, such as utilizing savings, selling assets, or acquiring external financial ...support (EFS) by borrowing with interest. Households' probability of acquiring EFS and its amount (intensity) depends on its social capital – the nature of social relationships and resources embedded within social networks. This study examines the effect of social capital on the probability and intensity of EFS during health events in Uttar Pradesh (UP), India. The analysis used data from a cross-sectional survey of 6218 households, reporting 3066 healthcare events, from two districts of UP. Household heads (HH) reported demographic, socioeconomic, and health-related information, including EFS, for each household member. Self-reported data from Shortened and Adapted Social Capital Assessment Tool in India (SASCAT-I) was used to generate four unique social capital measures (organizational participation, social support, trust, and social cohesion) at HH and community-level, using multilevel confirmatory factor analysis. After descriptive analysis, two-part mixed-effect models were implemented to estimate the probability and intensity of EFS as a function of social capital measures, where multilevel mixed-effects probit regression was used as the first-part and multilevel mixed-effects linear model with log link and gamma distribution as the second-part. Controlling for all covariates, the probability of acquiring EFS significantly increased (p = 0.04) with higher social support of the HH and significantly decreased (p = 0.02) with higher community social cohesion. Conditional to receiving any EFS, higher social trust of the HH resulted in higher intensity of EFS (p = 0.09). Social support and trust may enable households to cope up with financial stress. However, controlling for the other dimensions of social capital, high cohesiveness with the community might restrict a household's access to external resources demonstrating the unintended effect of social capital exerted by formal or informal social control.
•Social support assists household head to acquire external financing for healthcare payment.•But higher social support may not secure higher intensity of receiving external financing.•However, trust is a catalyst to acquire more financing conditional of any external financing was acquire in the first place.•Living in a cohesive community may restrict access to external financial resources.
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