Institute for International Programs

North Bethesda, MD, United States

Institute for International Programs

North Bethesda, MD, United States
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Liu L.,Institute for International Programs | Liu L.,Family and Reproductive Health | Oza S.,London School of Hygiene and Tropical Medicine | Perin J.,Institute for International Programs | And 4 more authors.
The Lancet | Year: 2015

Summary Background Trend data for causes of child death are crucial to inform priorities for improving child survival by and beyond 2015. We report child mortality by cause estimates in 2000-13, and cause-specific mortality scenarios to 2030 and 2035. Methods We estimated the distributions of causes of child mortality separately for neonates and children aged 1-59 months. To generate cause-specific mortality fractions, we included new vital registration and verbal autopsy data. We used vital registration data in countries with adequate registration systems. We applied vital registration-based multicause models for countries with low under-5 mortality but inadequate vital registration, and updated verbal autopsy-based multicause models for high mortality countries. We used updated numbers of child deaths to derive numbers of deaths by causes. We applied two scenarios to derive cause-specific mortality in 2030 and 2035. Findings Of the 6·3 million children who died before age 5 years in 2013, 51·8% (3·257 million) died of infectious causes and 44% (2·761 million) died in the neonatal period. The three leading causes are preterm birth complications (0·965 million [15·4%, uncertainty range (UR) 9·8-24·5]; UR 0·615-1·537 million), pneumonia (0·935 million [14·9%, 13·0-16·8]; 0·817-1·057 million), and intrapartum-related complications (0·662 million [10·5%, 6·7-16·8]; 0·421-1·054 million). Reductions in pneumonia, diarrhoea, and measles collectively were responsible for half of the 3·6 million fewer deaths recorded in 2013 versus 2000. Causes with the slowest progress were congenital, preterm, neonatal sepsis, injury, and other causes. If present trends continue, 4·4 million children younger than 5 years will still die in 2030. Furthermore, sub-Saharan Africa will have 33% of the births and 60% of the deaths in 2030, compared with 25% and 50% in 2013, respectively. Interpretation Our projection results provide concrete examples of how the distribution of child causes of deaths could look in 15-20 years to inform priority setting in the post-2015 era. More evidence is needed about shifts in timing, causes, and places of under-5 deaths to inform child survival agendas by and beyond 2015, to end preventable child deaths in a generation, and to count and account for every newborn and every child. Funding Bill & Melinda Gates Foundation. © 2015 Elsevier Ltd.

Requejo J.H.,Newborn and Child Health | Requejo J.H.,Institute for International Programs | Bhutta Z.A.,Institute for International Programs | Bhutta Z.A.,Hospital for Sick Children | Bhutta Z.A.,Aga Khan University
Archives of Disease in Childhood | Year: 2015

In this article, we draw on available evidence from Countdown to 2015 and other sources to make the case for keeping women and children at the heart of the next development agenda that will replace the Millennium Development Goal (MDG) framework after 2015. We provide a status update on global progress in achieving MDGs 4 and 5, reduce child mortality and improve maternal health, respectively - showing that although considerable mortality reductions have been achieved, many more women's and children's lives can be saved every day through available, cost effective interventions. We describe key underlying determinants of poor maternal and child health outcomes and the need for well-coordinated, comprehensive approaches for addressing them such as introducing a combination of nutrition specific and sensitive interventions to reduce pervasive malnutrition, targeting interventions to the underserved to reduce inequities in access to care, and increasing women's social status through improved access to education and income-earning opportunities. In the wake of population momentum and emergencies such as the recent ebola outbreak and other humanitarian crises, health systems must be strengthened to be able to respond to these pressures. In conclusion, we underscore that the unfinished business of women's and children's health must be prioritized in the days ahead, and that ending preventable maternal and child deaths is not only a moral obligation but is achievable and essential to sustainable development moving forward.

Victora C.G.,Federal University of Pelotas | Bahl R.,Child and Adolescent Health MCA | Barros A.J.D.,Federal University of Pelotas | Franca G.V.A.,Federal University of Pelotas | And 6 more authors.
The Lancet | Year: 2016

The importance of breastfeeding in low-income and middle-income countries is well recognised, but less consensus exists about its importance in high-income countries. In low-income and middle-income countries, only 37% of children younger than 6 months of age are exclusively breastfed. With few exceptions, breastfeeding duration is shorter in high-income countries than in those that are resource-poor. Our meta-analyses indicate protection against child infections and malocclusion, increases in intelligence, and probable reductions in overweight and diabetes. We did not find associations with allergic disorders such as asthma or with blood pressure or cholesterol, and we noted an increase in tooth decay with longer periods of breastfeeding. For nursing women, breastfeeding gave protection against breast cancer and it improved birth spacing, and it might also protect against ovarian cancer and type 2 diabetes. The scaling up of breastfeeding to a near universal level could prevent 823 000 annual deaths in children younger than 5 years and 20 000 annual deaths from breast cancer. Recent epidemiological and biological findings from during the past decade expand on the known benefits of breastfeeding for women and children, whether they are rich or poor. © 2016 Elsevier Ltd.

Amouzou A.,Institute for International Programs | Habi O.,Institute National Of La Statistique Du Niger | Bensaid K.,UN Childrens Fund UNICEF Niger
The Lancet | Year: 2012

Background The Millennium Development Goal 4 (MDG 4) is to reduce by two-thirds the mortality rate of children younger than 5 years, between 1990 and 2015. The 2012 Countdown profile shows that Niger has achieved far greater reductions in child mortality and gains in coverage for interventions in child survival than neighbouring countries in west Africa. Countdown therefore invited Niger to do an in-depth analysis of their child survival programme between 1998 and 2009. Methods We developed new estimates of child and neonatal mortality for 1998-2009 using a 2010 household survey. We recalculated coverage indicators using eight nationally-representative surveys for that period, and documented maternal, newborn, and child health programmes and policies since 1995. We used the Lives Saved Tool (LiST) to estimate the child lives saved in 2009. Findings The mortality rate in children younger than 5 years declined significantly from 226 deaths per 1000 livebirths (95% CI 207-246) in 1998 to 128 deaths (117-140) in 2009, an annual rate of decline of 5•1%. Stunting prevalence decreased slightly in children aged 24-35 months, and wasting declined by about 50% with the largest decreases in children younger than 2 years. Coverage increased greatly for most child survival interventions in this period. Results from LiST show that about 59 000 lives were saved in children younger than 5 years in 2009, attributable to the introduction of insecticide-treated bednets (25%); improvements in nutritional status (19%); vitamin A supplementation (9%); treatment of diarrhoea with oral rehydration salts and zinc, and careseeking for fever, malaria, or childhood pneumonia (22%); and vaccinations (11%). Interpretation Government policies supporting universal access, provision of free health care for pregnant women and children, and decentralised nutrition programmes permitted Niger to decrease child mortality at a pace that exceeds that needed to meet the MDG 4. Funding Bill &Melinda Gates Foundation; World Bank; Governments of Australia, Canada, Norway, Sweden, and the UK; and UNICEF.

Requejo J.H.,Institute for International Programs | Belizan J.M.,Institute for Clinical Effectiveness and Health Policy
Reproductive Health | Year: 2013

The last innovation in operative vaginal delivery happened centuries ago with the invention of the forceps and the vacuum extractor. The World Health Organization Odon Device Research Group recently published a protocol for a feasibility and safety study for a new device (Odon device) which aims to revolutionize assisted vaginal delivery. This editorial discusses the device and its pathway to global use. Although preliminary results look promising, the rigorous three-phased WHO protocol needs completion before the device can be determined, based on the evidence, to be safe and effective. © 2013 Requejo and Belizán; licensee BioMed Central Ltd.

Requejo J.,Newborn and Child Health | Victora C.,Federal University of Pelotas | Bryce J.,Institute for International Programs
International Journal of Epidemiology | Year: 2014

The Countdown to 2015 country profiles present, in one place, comprehensive evidence to enable an assessment of a country's progress in improving reproductive, maternal, newborn and child health. Profiles are available for each of the 75 countries that together account for more than 95% of all maternal and child deaths. The two-page profiles are updated approximately every 2 years with new data and analyses. Profile data include demographics, mortality, nutritional status, coverage of evidence-based interventions, within-countries inequalities in coverage, measures of health system functionality, supportive policies and financing indicators. The main sources of data for the coverage, nutritional status and equity indicators are the US Agency for Internal Development (USAID)-supported demographic and health surveys and the United Nations Children's Fund (UNICEF)-supported multiple indicator cluster surveys. Data on coverage are first summarized and checked for quality by UNICEF, and data on equity in intervention coverage are summarized and checked by the Federal University of Pelotas. The mortality estimates are developed by the Inter-agency Group for Child Mortality Estimation and the Maternal Mortality Estimation Inter-Agency Group. The financing data are abstracted from datasets maintained by the Organization for Economic Co-operation and Development Assistance Committee, and the policies and health systems data are derived from a special compilation prepared by the World Health Organization. Associated country profiles include equity-specific profiles and one-page profiles prepared annually that report on the 11 indicators selected by the Commission on Information and Accountability for Women's and Children's Health. © The Author 2014.

Bryce J.,Institute for International Programs | Victora C.G.,Federal University of Pelotas | Black R.E.,Institute for International Programs
The Lancet | Year: 2013

10 years ago, The Lancet published a Series about child survival. In this Review, we examine progress in the past decade in child survival, with a focus on epidemiology, interventions and intervention coverage, strategies of health programmes, equity, evidence, accountability, and global leadership. Knowledge of child health epidemiology has greatly increased, and although more and better interventions are available, they still do not reach large numbers of mothers and children. Child survival should remain at the heart of global goals in the post-2015 era. Many countries are now making good progress and need the time and support required to finish the task. The global health community should show its steadfast commitment to child survival by amassing knowledge and experience as a basis for ever more effective programmes. Leadership and accountability for child survival should be strengthened and shared among the UN system; governments in high-income, middle-income, and low-income countries; and non-governmental organisations. © 2013 Elsevier Ltd.

Walker N.,Institute for International Programs | Yenokyan G.,Johns Hopkins Biostatistics Center | Friberg I.K.,Institute for International Programs | Bryce J.,Institute for International Programs
The Lancet | Year: 2013

Background Urgent calls have been made for improved understanding of changes in coverage of maternal, newborn, and child health interventions, and their country-level determinants. We examined historical trends in coverage of interventions with proven effectiveness, and used them to project rates of child and neonatal mortality in 2035 in 74 Countdown to 2015 priority countries. Methods We investigated coverage of all interventions for which evidence was available to suggest effective reductions in maternal and child mortality, for which indicators have been defined, and data have been obtained through household surveys. We reanalysed coverage data from 312 nationally- representative household surveys done between 1990 and 2011 in 69 countries, including 58 Countdown countries. We developed logistic Loess regression models for patterns of coverage change for each intervention, and used k-means cluster analysis to divide interventions into three groups with different historical patterns of coverage change. Within each intervention group, we examined performance of each country in achieving coverage gains. We constructed models that included baseline coverage, region, gross domestic product, conflict, and governance to examine country-specific annual percentage coverage change for each group of indicators. We used the Lives Saved Tool (LiST) to predict mortality rates of children younger than 5 years (henceforth, under 5) and in the neonatal period in 2035 for Countdown countries if trends in coverage continue unchanged (historical trends scenario) and if each country accelerates intervention coverage to the highest level achieved by a Countdown country with similar baseline coverage level (best performer scenario). Results Odds of coverage of three interventions (antimalarial treatment, skilled attendant at birth, and use of improved sanitation facilities) have decreased since 1990, with a mean annual decrease of 5·5% (SD 2·7%). Odds of coverage of four interventions - all related to the prevention of malaria - have increased rapidly, with a mean annual increase of 27·9% (7·3%). Odds of coverage of other interventions have slowly increased, with a mean annual increase of 5·3% (3·5%). Rates of coverage change varied widely across countries; we could not explain the differences by measures of gross domestic product, conflict, or governance. On the basis of LiST projections, we predicted that the number of Countdown countries with an under-5 mortality rate of fewer than 20 deaths per 1000 livebirths per year would increase from four (5%) of the 74 in 2010, to nine (12%) by 2035 under the historical trends scenario, and to 15 (20%) under the best performer scenario. The number of countries with neonatal mortality rates of fewer than 11 per 1000 livebirths per year would increase from three (4%) in 2010, to ten (14%) by 2035 under the historical trends scenario, and 67 (91%) under the best performer scenario. The number of under-5 deaths per year would decrease from an estimated 7·6 million in 2010, to 5·4 million (28% decrease) if historical trends continue, and to 2·3 million (71% decrease) under the best performer scenario. Interpretation Substantial reductions in child deaths are possible, but only if intensified efforts to achieve intervention coverage are implemented successfully within each of the Countdown countries. Funding The Bill & Melinda Gates Foundation. © 2013 Elsevier Ltd.

Hazel E.,Institute for International Programs | Requejo J.,Institute for International Programs | David J.,Institute for International Programs | Bryce J.,Institute for International Programs
PLoS Medicine | Year: 2013

Community case management (CCM) is a strategy for training and supporting workers at the community level to provide treatment for the three major childhood diseases-diarrhea, fever (indicative of malaria), and pneumonia-as a complement to facility-based care. Many low- and middle-income countries are now implementing CCM and need to evaluate whether adoption of the strategy is associated with increases in treatment coverage. In this review, we assess the extent to which large-scale, national household surveys can serve as sources of baseline data for evaluating trends in community-based treatment coverage for childhood illnesses. Our examination of the questionnaires used in Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) conducted between 2005 and 2010 in five sub-Saharan African countries shows that questions on care seeking that included a locally adapted option for a community-based provider were present in all the DHS surveys and in some MICS surveys. Most of the surveys also assessed whether appropriate treatments were available, but only one survey collected information on the place of treatment for all three illnesses. This absence of baseline data on treatment source in household surveys will limit efforts to evaluate the effects of the introduction of CCM strategies in the study countries. We recommend alternative analysis plans for assessing CCM programs using household survey data that depend on baseline data availability and on the timing of CCM policy implementation. © 2013 Hazel et al.

Fischer Walker C.L.,Institute for International Programs | Walker N.,Institute for International Programs
BMC Medicine | Year: 2014

Background: Diarrhea 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.Discussion: LiST 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.Summary: LiST 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. © 2014 Fischer Walker and Walker; licensee BioMed Central Ltd.

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