Achieving MDG 4 in Sub-Saharan Africa: What Has Contributed to the Accelerated Child Mortality Decline in Ghana?
Identifieur interne : 000400 ( Pmc/Checkpoint ); précédent : 000399; suivant : 000401Achieving MDG 4 in Sub-Saharan Africa: What Has Contributed to the Accelerated Child Mortality Decline in Ghana?
Auteurs : Haruyo Nakamura [Japon] ; Nayu Ikeda [Japon] ; Andrew Stickley [Japon, Royaume-Uni] ; Rintaro Mori [Japon] ; Kenji Shibuya [Japon]Source :
- PLoS ONE [ 1932-6203 ] ; 2011.
Abstract
Recent analyses have suggested an accelerated decline in child mortality in Ghana since 2000. This study examines the long-term child mortality trends in the country, relates them to changes in the key drivers of mortality decline, and assesses the feasibility of the country's MDG 4 attainment.
Data from five Demographic and Health Surveys (DHS) between 1988 and 2008 and the Maternal Health Survey 2007 were used to generate two-year estimates of under-five mortality rates back to 1967. Lowess regression fitted past and future trends towards 2015. A modified Poisson approach was applied on the person-period data created from the DHS 2003 and 2008 to examine determinants of under-five mortality and their contributions to the change in mortality. A policy-modelling system assessed the feasibility of the country's MDG 4 attainment.
The under-five mortality rate has steadily declined over the past 40 years with acceleration since 2000, and is projected to reach between 45 and 69 per 1000 live births in 2015. Preceding birth interval (reference: 36+ months, relative risk [RR] increased as the interval shortened), bed net use (RR 0.71, 95% confidence interval [CI]: 0.52–0.95), maternal education (reference: secondary/higher, RR 1.71, 95% CI: 1.18–2.47 for primary), and maternal age at birth (reference: 17+ years, RR 2.13, 95% CI: 1.12–4.05) were primarily associated with under-five mortality. Increased bed-net use made a substantial contribution to the mortality decline. The scale-up of key interventions will allow the possibility of Ghana's MDG 4 attainment.
National and global efforts for scaling up key child survival interventions in Ghana are paying off ― these concerted efforts need to be sustained in order to achieve MDG 4.
Url:
DOI: 10.1371/journal.pone.0017774
PubMed: 21445299
PubMed Central: 3061869
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Accelerated Child Mortality Decline in Ghana?</title><author><name sortKey="Nakamura, Haruyo" sort="Nakamura, Haruyo" uniqKey="Nakamura H" first="Haruyo" last="Nakamura">Haruyo Nakamura</name><affiliation wicri:level="3"><nlm:aff id="aff1"><addr-line>Japan International Cooperation Agency (JICA), Tokyo, Japan</addr-line></nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Japan International Cooperation Agency (JICA), Tokyo</wicri:regionArea><placeName><settlement type="city">Tokyo</settlement><region type="région">Région de Kantō</region></placeName></affiliation></author><author><name sortKey="Ikeda, Nayu" sort="Ikeda, Nayu" uniqKey="Ikeda N" first="Nayu" last="Ikeda">Nayu Ikeda</name><affiliation wicri:level="3"><nlm:aff id="aff2"><addr-line>Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan</addr-line></nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo</wicri:regionArea><placeName><settlement type="city">Tokyo</settlement><region type="région">Région de Kantō</region></placeName></affiliation></author><author><name sortKey="Stickley, Andrew" sort="Stickley, Andrew" uniqKey="Stickley A" first="Andrew" last="Stickley">Andrew Stickley</name><affiliation wicri:level="3"><nlm:aff id="aff2"><addr-line>Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan</addr-line></nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo</wicri:regionArea><placeName><settlement type="city">Tokyo</settlement><region type="région">Région de Kantō</region></placeName></affiliation><affiliation wicri:level="3"><nlm:aff id="aff3"><addr-line>London School of Hygiene and Tropical Medicine, London, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>London School of Hygiene and Tropical Medicine, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Mori, Rintaro" sort="Mori, Rintaro" uniqKey="Mori R" first="Rintaro" last="Mori">Rintaro Mori</name><affiliation wicri:level="3"><nlm:aff id="aff2"><addr-line>Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan</addr-line></nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo</wicri:regionArea><placeName><settlement type="city">Tokyo</settlement><region type="région">Région de Kantō</region></placeName></affiliation></author><author><name sortKey="Shibuya, Kenji" sort="Shibuya, Kenji" uniqKey="Shibuya K" first="Kenji" last="Shibuya">Kenji Shibuya</name><affiliation wicri:level="3"><nlm:aff id="aff2"><addr-line>Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan</addr-line></nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo</wicri:regionArea><placeName><settlement type="city">Tokyo</settlement><region type="région">Région de Kantō</region></placeName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">21445299</idno><idno type="pmc">3061869</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3061869</idno><idno type="RBID">PMC:3061869</idno><idno type="doi">10.1371/journal.pone.0017774</idno><date when="2011">2011</date><idno type="wicri:Area/Pmc/Corpus">000491</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000491</idno><idno type="wicri:Area/Pmc/Curation">000490</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000490</idno><idno type="wicri:Area/Pmc/Checkpoint">000400</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">000400</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Achieving MDG 4 in Sub-Saharan Africa: What Has Contributed to the
Accelerated Child Mortality Decline in Ghana?</title><author><name sortKey="Nakamura, Haruyo" sort="Nakamura, Haruyo" uniqKey="Nakamura H" first="Haruyo" last="Nakamura">Haruyo Nakamura</name><affiliation wicri:level="3"><nlm:aff id="aff1"><addr-line>Japan International Cooperation Agency (JICA), Tokyo, Japan</addr-line></nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Japan International Cooperation Agency (JICA), Tokyo</wicri:regionArea><placeName><settlement type="city">Tokyo</settlement><region type="région">Région de Kantō</region></placeName></affiliation></author><author><name sortKey="Ikeda, Nayu" sort="Ikeda, Nayu" uniqKey="Ikeda N" first="Nayu" last="Ikeda">Nayu Ikeda</name><affiliation wicri:level="3"><nlm:aff id="aff2"><addr-line>Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan</addr-line></nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo</wicri:regionArea><placeName><settlement type="city">Tokyo</settlement><region type="région">Région de Kantō</region></placeName></affiliation></author><author><name sortKey="Stickley, Andrew" sort="Stickley, Andrew" uniqKey="Stickley A" first="Andrew" last="Stickley">Andrew Stickley</name><affiliation wicri:level="3"><nlm:aff id="aff2"><addr-line>Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan</addr-line></nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo</wicri:regionArea><placeName><settlement type="city">Tokyo</settlement><region type="région">Région de Kantō</region></placeName></affiliation><affiliation wicri:level="3"><nlm:aff id="aff3"><addr-line>London School of Hygiene and Tropical Medicine, London, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>London School of Hygiene and Tropical Medicine, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Mori, Rintaro" sort="Mori, Rintaro" uniqKey="Mori R" first="Rintaro" last="Mori">Rintaro Mori</name><affiliation wicri:level="3"><nlm:aff id="aff2"><addr-line>Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan</addr-line></nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo</wicri:regionArea><placeName><settlement type="city">Tokyo</settlement><region type="région">Région de Kantō</region></placeName></affiliation></author><author><name sortKey="Shibuya, Kenji" sort="Shibuya, Kenji" uniqKey="Shibuya K" first="Kenji" last="Shibuya">Kenji Shibuya</name><affiliation wicri:level="3"><nlm:aff id="aff2"><addr-line>Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan</addr-line></nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo</wicri:regionArea><placeName><settlement type="city">Tokyo</settlement><region type="région">Région de Kantō</region></placeName></affiliation></author></analytic><series><title level="j">PLoS ONE</title><idno type="eISSN">1932-6203</idno><imprint><date when="2011">2011</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Recent analyses have suggested an accelerated decline in child mortality in
Ghana since 2000. This study examines the long-term child mortality trends
in the country, relates them to changes in the key drivers of mortality
decline, and assesses the feasibility of the country's MDG 4
attainment.</p></sec><sec><title>Methodology</title><p>Data from five Demographic and Health Surveys (DHS) between 1988 and 2008 and
the Maternal Health Survey 2007 were used to generate two-year estimates of
under-five mortality rates back to 1967. Lowess regression fitted past and
future trends towards 2015. A modified Poisson approach was applied on the
person-period data created from the DHS 2003 and 2008 to examine
determinants of under-five mortality and their contributions to the change
in mortality. A policy-modelling system assessed the feasibility of the
country's MDG 4 attainment.</p></sec><sec><title>Findings</title><p>The under-five mortality rate has steadily declined over the past 40 years
with acceleration since 2000, and is projected to reach between 45 and 69
per 1000 live births in 2015. Preceding birth interval (reference: 36+
months, relative risk [RR] increased as the interval shortened),
bed net use (RR 0.71, 95% confidence interval [CI]:
0.52–0.95), maternal education (reference: secondary/higher, RR 1.71,
95% CI: 1.18–2.47 for primary), and maternal age at birth
(reference: 17+ years, RR 2.13, 95% CI: 1.12–4.05) were
primarily associated with under-five mortality. Increased bed-net use made a
substantial contribution to the mortality decline. The scale-up of key
interventions will allow the possibility of Ghana's MDG 4
attainment.</p></sec><sec><title>Conclusions</title><p>National and global efforts for scaling up key child survival interventions
in Ghana are paying off ― these concerted efforts need to be
sustained in order to achieve MDG 4.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Unicef" uniqKey="Unicef">UNICEF</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Unicef" uniqKey="Unicef">UNICEF</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Bhutta, Za" uniqKey="Bhutta Z">ZA Bhutta</name></author><author><name sortKey="Chopra, M" uniqKey="Chopra M">M Chopra</name></author><author><name sortKey="Axelson, H" uniqKey="Axelson H">H Axelson</name></author><author><name sortKey="Peter, B" uniqKey="Peter B">B Peter</name></author><author><name sortKey="Jennifer, B" uniqKey="Jennifer B">B Jennifer</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Rajaratnam, Jk" uniqKey="Rajaratnam J">JK Rajaratnam</name></author><author><name sortKey="Marcus, Jr" uniqKey="Marcus J">JR 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<front><journal-meta><journal-id journal-id-type="nlm-ta">PLoS One</journal-id><journal-id journal-id-type="publisher-id">plos</journal-id><journal-id journal-id-type="pmc">plosone</journal-id><journal-title-group><journal-title>PLoS ONE</journal-title></journal-title-group><issn pub-type="epub">1932-6203</issn><publisher><publisher-name>Public Library of Science</publisher-name><publisher-loc>San Francisco, USA</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">21445299</article-id><article-id pub-id-type="pmc">3061869</article-id><article-id pub-id-type="publisher-id">PONE-D-10-02772</article-id><article-id pub-id-type="doi">10.1371/journal.pone.0017774</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="Discipline-v2"><subject>Medicine</subject><subj-group><subject>Global Health</subject></subj-group><subj-group><subject>Non-Clinical Medicine</subject><subj-group><subject>Health Care Policy</subject><subject>Health Services Research</subject><subject>Socioeconomic Aspects of Health</subject></subj-group></subj-group><subj-group><subject>Public Health</subject><subj-group><subject>Child Health</subject></subj-group></subj-group></subj-group></article-categories><title-group><article-title>Achieving MDG 4 in Sub-Saharan Africa: What Has Contributed to the
Accelerated Child Mortality Decline in Ghana?</article-title><alt-title alt-title-type="running-head">Accelerated Child Mortality Decline in
Ghana</alt-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Nakamura</surname><given-names>Haruyo</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref ref-type="corresp" rid="cor1"><sup>*</sup></xref></contrib><contrib contrib-type="author"><name><surname>Ikeda</surname><given-names>Nayu</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Stickley</surname><given-names>Andrew</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref><xref ref-type="aff" rid="aff3"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Mori</surname><given-names>Rintaro</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Shibuya</surname><given-names>Kenji</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib></contrib-group><aff id="aff1"><label>1</label><addr-line>Japan International Cooperation Agency (JICA), Tokyo, Japan</addr-line></aff><aff id="aff2"><label>2</label><addr-line>Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan</addr-line></aff><aff id="aff3"><label>3</label><addr-line>London School of Hygiene and Tropical Medicine, London, United Kingdom</addr-line></aff><contrib-group><contrib contrib-type="editor"><name><surname>Vitzthum</surname><given-names>Virginia</given-names></name><role>Editor</role><xref ref-type="aff" rid="edit1"></xref></contrib></contrib-group><aff id="edit1">Indiana University, United States of America</aff><author-notes><corresp id="cor1">* E-mail: <email>fv5h-smz@asahi-net.or.jp</email></corresp><fn fn-type="con"><p>Conceived and designed the experiments: HN NI KS. Performed the experiments:
HN NI. Analyzed the data: HN NI. Contributed reagents/materials/analysis
tools: HN NI KS. Wrote the paper: HN. Interpreted data: NH NI AS RM KS.
Revised the manuscript for intellectual content: NI AS RM KS. Revised the
manuscript for language content: AS. Supervised the study: KS.</p></fn></author-notes><pub-date pub-type="collection"><year>2011</year></pub-date><pub-date pub-type="epub"><day>21</day><month>3</month><year>2011</year></pub-date><volume>6</volume><issue>3</issue><elocation-id>e17774</elocation-id><history><date date-type="received"><day>25</day><month>9</month><year>2010</year></date><date date-type="accepted"><day>14</day><month>2</month><year>2011</year></date></history><permissions><copyright-statement>Nakamura et al. This is an open-access article distributed under
the terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original author and
source are credited.</copyright-statement></permissions><abstract><sec><title>Background</title><p>Recent analyses have suggested an accelerated decline in child mortality in
Ghana since 2000. This study examines the long-term child mortality trends
in the country, relates them to changes in the key drivers of mortality
decline, and assesses the feasibility of the country's MDG 4
attainment.</p></sec><sec><title>Methodology</title><p>Data from five Demographic and Health Surveys (DHS) between 1988 and 2008 and
the Maternal Health Survey 2007 were used to generate two-year estimates of
under-five mortality rates back to 1967. Lowess regression fitted past and
future trends towards 2015. A modified Poisson approach was applied on the
person-period data created from the DHS 2003 and 2008 to examine
determinants of under-five mortality and their contributions to the change
in mortality. A policy-modelling system assessed the feasibility of the
country's MDG 4 attainment.</p></sec><sec><title>Findings</title><p>The under-five mortality rate has steadily declined over the past 40 years
with acceleration since 2000, and is projected to reach between 45 and 69
per 1000 live births in 2015. Preceding birth interval (reference: 36+
months, relative risk [RR] increased as the interval shortened),
bed net use (RR 0.71, 95% confidence interval [CI]:
0.52–0.95), maternal education (reference: secondary/higher, RR 1.71,
95% CI: 1.18–2.47 for primary), and maternal age at birth
(reference: 17+ years, RR 2.13, 95% CI: 1.12–4.05) were
primarily associated with under-five mortality. Increased bed-net use made a
substantial contribution to the mortality decline. The scale-up of key
interventions will allow the possibility of Ghana's MDG 4
attainment.</p></sec><sec><title>Conclusions</title><p>National and global efforts for scaling up key child survival interventions
in Ghana are paying off ― these concerted efforts need to be
sustained in order to achieve MDG 4.</p></sec></abstract><counts><page-count count="6"></page-count></counts></article-meta></front></pmc><affiliations><list><country><li>Japon</li><li>Royaume-Uni</li></country><region><li>Angleterre</li><li>Grand Londres</li><li>Région de Kantō</li></region><settlement><li>Londres</li><li>Tokyo</li></settlement></list><tree><country name="Japon"><region name="Région de Kantō"><name sortKey="Nakamura, Haruyo" sort="Nakamura, Haruyo" uniqKey="Nakamura H" first="Haruyo" last="Nakamura">Haruyo Nakamura</name></region><name sortKey="Ikeda, Nayu" sort="Ikeda, Nayu" uniqKey="Ikeda N" first="Nayu" last="Ikeda">Nayu Ikeda</name><name sortKey="Mori, Rintaro" sort="Mori, Rintaro" uniqKey="Mori R" first="Rintaro" last="Mori">Rintaro Mori</name><name sortKey="Shibuya, Kenji" sort="Shibuya, Kenji" uniqKey="Shibuya K" first="Kenji" last="Shibuya">Kenji Shibuya</name><name sortKey="Stickley, Andrew" sort="Stickley, Andrew" uniqKey="Stickley A" first="Andrew" last="Stickley">Andrew Stickley</name></country><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Stickley, Andrew" sort="Stickley, Andrew" uniqKey="Stickley A" first="Andrew" last="Stickley">Andrew Stickley</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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