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Olalekan A. Uthman - One of the best experts on this subject based on the ideXlab platform.
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Factors That Predict Differences in Childhood Mortality in Nigerian Communities: A Prognostic Model.
The Journal of pediatrics, 2015Co-Authors: Victor Adekanmbi, Ngianga-bakwin Kandala, Saverio Stranges, Olalekan A. UthmanAbstract:Objective To identify predictors of variations of Childhood Mortality between Nigerian communities and to identify high-risk communities where Childhood Mortality was higher than expected. Study design Secondary analysis of the 2013 Nigeria Demographic and Health Survey data using prognostic univariable and multivariable mixed Poisson regression models. Likelihood ratio test, Hosmer-Lemeshow goodness-of-fit, and variance inflation factor were used to evaluate the fitness of the final model. Results The final adjusted model revealed that communities with high rating of multiple Childhood deprivation (relative risk 1.14, 95% CI 1.09-1.19) and maternal socioeconomic deprivation (relative risk 1.22, 95% CI 1.14-1.29) were associated significantly with the risk of Childhood Mortality. Communities with enhanced maternal hospital-based health-seeking behaviors and more advantageous environmental conditions had reduced risks of Childhood Mortality. Similarly, children living in communities with high ethnic diversity were significantly less likely to die before their fifth birthday (relative risk 0.96, 95% CI 0.94-0.97). About 64% of the observed heterogeneity in Childhood Mortality in these communities was explained by the final model. Eleven of the 896 communities had higher than expected Childhood Mortality rates during the study period. Conclusions Of the 31 482 children included in this survey, 2886 had died before their fifth birthday (128 deaths per 1000 live births). There are variations in Childhood Mortality across Nigerian communities that are not determined only by health system functions but also by factors beyond the scope of health authorities and healthcare delivery systems.
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Contextual socioeconomic factors associated with Childhood Mortality in Nigeria: a multilevel analysis
Journal of epidemiology and community health, 2015Co-Authors: Victor Adekanmbi, Ngianga-bakwin Kandala, Saverio Stranges, Olalekan A. UthmanAbstract:Background Childhood Mortality is a well-known public health issue, particularly in the low and middle income countries. The overarching aim of this study was to examine whether neighbourhood socioeconomic disadvantage is associated with Childhood Mortality beyond individual-level measures of socioeconomic status in Nigeria. Methods Multilevel logistic regression models were applied to data on 31 482 under-five children whether alive or dead (level 1) nested within 896 neighbourhoods (level 2) from the 37 states in Nigeria (level 3) using the most recent 2013 Nigeria Demographic and Health Survey (DHS). Results More than 1 of every 10 children studied had died before reaching the age of 5 years (130/1000 live births). The following factors independently increased the odds of Childhood Mortality: male sex, mother9s age at 15–24 years, uneducated mother or low maternal education attainment, decreasing household wealth index at individual level (level 1), residing in rural area and neighbourhoods with high poverty rate at level 2. There were significant neighbourhoods and states clustering in Childhood Mortality in Nigeria. Conclusions The study provides evidence that individual-level and neighbourhood-level socioeconomic conditions are important correlates of Childhood Mortality in Nigeria. The findings of this study also highlight the need to implement public health prevention strategies at the individual level, as well as at the area/neighbourhood level. These strategies include the establishment of an effective publicly funded healthcare system, as well as health education and poverty alleviation programmes.
Victor Adekanmbi - One of the best experts on this subject based on the ideXlab platform.
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Factors That Predict Differences in Childhood Mortality in Nigerian Communities: A Prognostic Model.
The Journal of pediatrics, 2015Co-Authors: Victor Adekanmbi, Ngianga-bakwin Kandala, Saverio Stranges, Olalekan A. UthmanAbstract:Objective To identify predictors of variations of Childhood Mortality between Nigerian communities and to identify high-risk communities where Childhood Mortality was higher than expected. Study design Secondary analysis of the 2013 Nigeria Demographic and Health Survey data using prognostic univariable and multivariable mixed Poisson regression models. Likelihood ratio test, Hosmer-Lemeshow goodness-of-fit, and variance inflation factor were used to evaluate the fitness of the final model. Results The final adjusted model revealed that communities with high rating of multiple Childhood deprivation (relative risk 1.14, 95% CI 1.09-1.19) and maternal socioeconomic deprivation (relative risk 1.22, 95% CI 1.14-1.29) were associated significantly with the risk of Childhood Mortality. Communities with enhanced maternal hospital-based health-seeking behaviors and more advantageous environmental conditions had reduced risks of Childhood Mortality. Similarly, children living in communities with high ethnic diversity were significantly less likely to die before their fifth birthday (relative risk 0.96, 95% CI 0.94-0.97). About 64% of the observed heterogeneity in Childhood Mortality in these communities was explained by the final model. Eleven of the 896 communities had higher than expected Childhood Mortality rates during the study period. Conclusions Of the 31 482 children included in this survey, 2886 had died before their fifth birthday (128 deaths per 1000 live births). There are variations in Childhood Mortality across Nigerian communities that are not determined only by health system functions but also by factors beyond the scope of health authorities and healthcare delivery systems.
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Unravelling the effects of neighbourhood contextual influences on Childhood Mortality and morbidity in Nigeria
2015Co-Authors: Victor AdekanmbiAbstract:Background: The burden of Childhood stunting and Mortality remains huge in developing countries and in particular in the Sub-Saharan Africa region to which Nigeria is located. Despite the body of evidence supporting an association between neighbourhood contextual influences and health outcomes, few studies have examined the relationship between neighbourhood-level risk factors and Childhood undernutrition (stunting) and Mortality independent of the individual-level risk factors in a single analytical framework in Nigeria. Most studies to date have focused on individual-level factors overlooking the contribution of neighbourhood or area level factors. Beyond the effect of neighbourhood contextual influences, a child’s health will be influenced by the state, region and national policies and programs that in turn will affect the proximate determinants of his or her survival and health status. Aims: We described the variation that existed between the states in Nigeria using league table, control chart and spatial clustering of Childhood stunting (Study I) and examined the contribution of community contextual factors at predicting Childhood stunting beyond individual-level factors (Study II). We further identified and examined the predictors of Childhood Mortality in Nigeria (Study III) and developed prognostic model predicting differences in Childhood Mortality in Nigeria communities (Study IV). We also quantified the contribution of neighbourhood socioeconomic disadvantage alongside individual-level socioeconomic status to Childhood Mortality in Nigeria using multilevel analysis (Study V). Methods: We used the Nigeria Demographic and Health Survey (DHS) dataset which comprised of 28,647 and 31,482 under-five children nested within 888 and 896 communities for the 2008 and 2013 surveys respectively from 37 states including the Federal Capital Territory. We used league table, control chart and geospatial analysis to describe variations in Childhood stunting that existed between the states in Nigeria (Study I). In study II, we applied multivariable multilevel logistic regression analysis to describe the independent contribution of community contextual influences (factors) alongside the individual level factors on Childhood stunting in Nigeria. We applied multivariable logistic regression analysis that included Receiver Operating Characteristics (ROC) Curve to construct a model that examined the factors associated with Childhood Mortality (Study III). In study IV, we used mixed multivariable Poisson regression analysis to develop a prognostic model predicting differences in Childhood Mortality in Nigeria communities. In Study V, we applied multivariable multilevel logistic regression analysis and considered three measures of individual socioeconomic status i.e. maternal educational attainment, household wealth status, and employment status of the mothers. At the neighbourhood (level 2) and state (level 3), we included poverty rate, unemployment rate, and illiteracy rate. Results: There were statistically significant variations in the odds of Childhood stunting and Mortality across the neighbourhoods (Study II, IV & V) and states (I) in Nigeria. This confirmed the evidence of community and state level contextual phenomenon influencing Childhood survival and stunting. Children residing in socioeconomically disadvantaged neighbourhoods had higher odds of Childhood morbidity and Mortality compared to their counterparts living in more socioeconomically advantageous neighbourhoods (Study II, IV & V). The odds of Childhood morbidity and Mortality were associated with neighbourhood and state socioecological conditions even after adjusting for individual’s household socioecological conditions (Study II, III, IV & V). There was moderate positive correlation between neighbourhood and individual variations in Childhood Mortality and morbidity (Study II & V). The odds of Childhood stunting and Mortality were higher in children residing in rural areas (Study II, III, IV & V) and in settings with poor sanitation (Study III & IV). Other factors that increased the odds of Childhood Mortality included low level of maternal health seeking behaviour, not breastfed for >18 months, being from a polygamous family setting, large family and high birth order, non-usage of contraceptive by mother, and mother having first marriage during their teenage years(Study III). Good household wealth status, adequate birth interval, being a female child and having normal birth weight, increasing maternal educational attainment were all associated with odds of not suffering from Childhood stunting and surviving beyond five years of age (Study II & V). Conclusions: By adopting several modelling approaches including the multilevel modelling, we added to the growing body of evidence the effects of the neighbourhood contextual influences on Childhood stunting and survival in Nigeria. Our study revealed that individual i.e. children and parental factors; neighbourhood and socioecological environment were associated with Childhood stunting and Mortality. Efforts at reducing the burden of Childhood stunting and Mortality should be directed at establishment of poverty alleviation programmes, effective publicly funded health care delivery, promotion of hygienic environmental practices and health education more importantly at the neighbourhood level. Lastly, given the importance of socioecological factors at influencing the lifestyles of neighbourhoods and individuals, interventions targeting structural make up of these two entities are vital in order to meet the MDGs 1 and 4 regarding Childhood stunting and Mortality in Nigeria and in particular developing countries in general.
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Contextual socioeconomic factors associated with Childhood Mortality in Nigeria: a multilevel analysis
Journal of epidemiology and community health, 2015Co-Authors: Victor Adekanmbi, Ngianga-bakwin Kandala, Saverio Stranges, Olalekan A. UthmanAbstract:Background Childhood Mortality is a well-known public health issue, particularly in the low and middle income countries. The overarching aim of this study was to examine whether neighbourhood socioeconomic disadvantage is associated with Childhood Mortality beyond individual-level measures of socioeconomic status in Nigeria. Methods Multilevel logistic regression models were applied to data on 31 482 under-five children whether alive or dead (level 1) nested within 896 neighbourhoods (level 2) from the 37 states in Nigeria (level 3) using the most recent 2013 Nigeria Demographic and Health Survey (DHS). Results More than 1 of every 10 children studied had died before reaching the age of 5 years (130/1000 live births). The following factors independently increased the odds of Childhood Mortality: male sex, mother9s age at 15–24 years, uneducated mother or low maternal education attainment, decreasing household wealth index at individual level (level 1), residing in rural area and neighbourhoods with high poverty rate at level 2. There were significant neighbourhoods and states clustering in Childhood Mortality in Nigeria. Conclusions The study provides evidence that individual-level and neighbourhood-level socioeconomic conditions are important correlates of Childhood Mortality in Nigeria. The findings of this study also highlight the need to implement public health prevention strategies at the individual level, as well as at the area/neighbourhood level. These strategies include the establishment of an effective publicly funded healthcare system, as well as health education and poverty alleviation programmes.
Ngianga-bakwin Kandala - One of the best experts on this subject based on the ideXlab platform.
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Factors That Predict Differences in Childhood Mortality in Nigerian Communities: A Prognostic Model.
The Journal of pediatrics, 2015Co-Authors: Victor Adekanmbi, Ngianga-bakwin Kandala, Saverio Stranges, Olalekan A. UthmanAbstract:Objective To identify predictors of variations of Childhood Mortality between Nigerian communities and to identify high-risk communities where Childhood Mortality was higher than expected. Study design Secondary analysis of the 2013 Nigeria Demographic and Health Survey data using prognostic univariable and multivariable mixed Poisson regression models. Likelihood ratio test, Hosmer-Lemeshow goodness-of-fit, and variance inflation factor were used to evaluate the fitness of the final model. Results The final adjusted model revealed that communities with high rating of multiple Childhood deprivation (relative risk 1.14, 95% CI 1.09-1.19) and maternal socioeconomic deprivation (relative risk 1.22, 95% CI 1.14-1.29) were associated significantly with the risk of Childhood Mortality. Communities with enhanced maternal hospital-based health-seeking behaviors and more advantageous environmental conditions had reduced risks of Childhood Mortality. Similarly, children living in communities with high ethnic diversity were significantly less likely to die before their fifth birthday (relative risk 0.96, 95% CI 0.94-0.97). About 64% of the observed heterogeneity in Childhood Mortality in these communities was explained by the final model. Eleven of the 896 communities had higher than expected Childhood Mortality rates during the study period. Conclusions Of the 31 482 children included in this survey, 2886 had died before their fifth birthday (128 deaths per 1000 live births). There are variations in Childhood Mortality across Nigerian communities that are not determined only by health system functions but also by factors beyond the scope of health authorities and healthcare delivery systems.
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Contextual socioeconomic factors associated with Childhood Mortality in Nigeria: a multilevel analysis
Journal of epidemiology and community health, 2015Co-Authors: Victor Adekanmbi, Ngianga-bakwin Kandala, Saverio Stranges, Olalekan A. UthmanAbstract:Background Childhood Mortality is a well-known public health issue, particularly in the low and middle income countries. The overarching aim of this study was to examine whether neighbourhood socioeconomic disadvantage is associated with Childhood Mortality beyond individual-level measures of socioeconomic status in Nigeria. Methods Multilevel logistic regression models were applied to data on 31 482 under-five children whether alive or dead (level 1) nested within 896 neighbourhoods (level 2) from the 37 states in Nigeria (level 3) using the most recent 2013 Nigeria Demographic and Health Survey (DHS). Results More than 1 of every 10 children studied had died before reaching the age of 5 years (130/1000 live births). The following factors independently increased the odds of Childhood Mortality: male sex, mother9s age at 15–24 years, uneducated mother or low maternal education attainment, decreasing household wealth index at individual level (level 1), residing in rural area and neighbourhoods with high poverty rate at level 2. There were significant neighbourhoods and states clustering in Childhood Mortality in Nigeria. Conclusions The study provides evidence that individual-level and neighbourhood-level socioeconomic conditions are important correlates of Childhood Mortality in Nigeria. The findings of this study also highlight the need to implement public health prevention strategies at the individual level, as well as at the area/neighbourhood level. These strategies include the establishment of an effective publicly funded healthcare system, as well as health education and poverty alleviation programmes.
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modeling spatial effects on Childhood Mortality via geo additive bayesian discrete time survival model a case study from nigeria
2014Co-Authors: Gebrenegus Ghilagaber, Diddy Antai, Ngianga-bakwin KandalaAbstract:Childhood Mortality is an important indicator of overall health and development in a country. It is the result of a complex interplay of determinants at many levels, and as such several studies have recognized that, for instance, maternal (Caldwell 1979; Cleland and van Ginneken 1988), socio-economic (Castro-Leal et al. 1999; Wagstaff 2001), and environmental (Wolfe and Behrman 1982; Lee et al. 1997) factors are important determinants of Childhood Mortality. However, only a few studies have incorporated environmental factors that are spatial in nature and derived from geographic databases, such as distances from households or communities (Watson et al. 1997).
Peter Aaby - One of the best experts on this subject based on the ideXlab platform.
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Hypothesis: Vitamin A supplementation and Childhood Mortality: amplification of the non-specific effects of vaccines?
International journal of epidemiology, 2003Co-Authors: Christine Stabell Benn, Carlitos Balé, Halvor Sommerfelt, Henrik Friis, Peter AabyAbstract:Most areas of health research will have accepted data and a dominating interpretation. If the interpretation is not correct, contradictions will accumulate, and it will eventually become clear that the current interpretation is untenable. In this situation, the best hypothesis is the one that accounts for all of the known data as well as the apparent contradictions. The area of vitamin A supplementation and Childhood Mortality in developing countries is afflicted with many contradictions and there is a need for a new hypothesis. We propose that the effect of vitamin A supplementation may depend on the amplification of non-specific effects of vaccines on Childhood Mortality.
G K Singh - One of the best experts on this subject based on the ideXlab platform.
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US Childhood Mortality, 1950 through 1993: Trends and socioeconomic diffferentials.
American journal of public health, 1996Co-Authors: G K SinghAbstract:OBJECTIVES: This study examined trends and differentials in US Childhood Mortality from 1950 through 1993 according to sex, race/ethnicity, education, family income, and cause of death. METHODS: Log-linear, multiple regression, and Cox proportional hazards regression models were applied to the data from the National Vital Statistics System, the National Longitudinal Mortality Study, and the Area Resource File. RESULTS: Substantial declines in US Childhood Mortality have occurred in the past 4 decades, primarily due to decreases in Mortality from unintentional injuries, cancer, pneumonia and influenza, and congenital anomalies. The overall declining trend, however, has been dampened by a twofold to threefold increase in the suicide and homicide rates among children since 1968. Male, Black, American Indian, Hawaiian, and Puerto Rican children and those in the lower socioeconomic strata were at an increased risk of death. CONCLUSIONS: Increasing trends in Mortality from violence, firearm injuries, and human ...