FACULTY OF PUBLIC HEALTH

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Start date: 2020Subject: search.filters.subject.Low- and middle-income countries

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    Sex inequality in under-five deaths and associated factors in low and middle-income countries: a Fairlie decomposition analysis
    (BioMed Central, 2022) Fagbamigbe, A. F.; Morakinyo, O. M.; Balogun, F. M.
    Background: There exist sex disparities in the burden of Under-five deaths (U5D) with a higher prevalence among male children. Factors explaining this inequality remain unexplored in Low-and Medium-Income Countries (LMIC). This study quantified the contributions of the individual- and neighborhood-level factors to sex inequalities in U5D in LMIC. Methods: Demographic and Health Survey datasets (2010-2018) of 856,987 under-five children nested in 66,495 neighborhoods across 59 LMIC were analyzed. The outcome variable was U5D. The main group variable was the sex of the child while individual-level and neighborhood-level factors were the explanatory variables. Fairlie decomposition analysis was used to quantify the contributions of explanatory factors to the male-female inequalities in U5D at p<0.05. Results: Overall weighted prevalence of U5D was 51/1000 children, 55 among males and 48 among females (p<0.001). Higher prevalence of U5D was recorded among male children in all countries except Liberia, Kyrgyz Republic, Bangladesh, Nepal, Armenia, Turkey and Papua New Guinea. Pro-female inequality was however not significant in any country. Of the 59 countries, 25 had statistically significant pro-male inequality. Different factors contributed to the sex inequality in U5D in different countries including birth order, birth weight, birth interval and multiple births. Conclusions: There were sex inequalities in the U5D in LMIC with prominent pro-male-inequality in many countries. Interventions targeted towards the improvement of the health system that will, in turn, prevent preterm delivery and improve management of prematurity and early childhood infection (which are selective threats to the male child survival) are urgently required to address this inequality.
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    Factors contributing to household wealth inequality in under-five deaths in low[1]and middle-income countries: decomposition analysis
    (BioMed Central, 2022) Fagbamigbe, A. F.; Adeniji, F. I. P.; Morakinyo, O. M.
    Background: The burden of under-5 deaths is disproportionately high among poor households relative to economically viable ones in developing countries. Despite this, the factors driving this inequality has not been well explored. This study decomposed the contributions of the factors associated with wealth inequalities in under-5 deaths in low and middle-income countries (LMICs). Methods: We analysed data of 856,987 children from 66,495 neighbourhoods across 59 LMICs spanning recent Demographic and Health Surveys (2010-2018). Under-5 mortality was described as deaths among live births within 0 to 59 months of birth and it was treated as a dichotomous variable (dead or alive). The prevalence of under-five deaths was stratified using household wealth status. A Fairlie decomposition analysis was utilized to investigate the relative contribution of the factors associated with household wealth inequality in under-5 deaths at p<0.05. The WHO health equity assessment toolkit Plus was used to assess the diferences (D) ratios (R), population attributable risk (PAR), and population attributable fraction (PAF) in household wealth inequalities across the countries. Results: The proportion of children from poor households was 45%. The prevalence of under-5 deaths in all samples was 51 per 1000 children, with 60 per 1000 and 44 per 1000 among children from poor and non-poor households (p<0.001). The prevalence of under-5 deaths was higher among children from poor households than those from non-poor households in all countries except in Ethiopia, Tanzania, Zambia, Lesotho, Gambia and Sierra Leone, and in the Maldives. Thirty-four of the 59 countries showed significantly higher under-5 deaths in poor households than in non-poor households (pro-non-poor inequality) and no significant pro-poor inequality. Rural-urban contexts, maternal education, neighborhood socioeconomic status, sex of the child, toilet kinds, birth weight and preceding birth intervals, and sources of drinking water are the most significant drivers of pro-poor inequities in under-5 deaths in these countries. Conclusions: Individual-level and neighbourhood-level factors were associated with a high prevalence of under-5 deaths among poor households in LMICs. Interventions in countries should focus on reducing the gap between the poor and the rich as well as improve the education and livelihood of disadvantaged people.
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    Decomposition analysis of the compositional and contextual factors associated with poor-non-poor inequality in diarrhoea among under-five children in low- and middle-income countries
    (Elsevier Ltd, 2021) Fagbamigbe, A. F.; Ologunwa, O. P.; Afolabi, E. K.; Fagbamigbe, O. S.; Uthman, A. O.
    Objectives: The aim of the study was to assess the magnitude of wealth inequalities in the development of diarrhoea among under-five children in low- and middle-income countries (LMICs) and to identify and quantify contextual and compositional factors' contribution to the inequalities. Design: This is a cross-sectional study. Methods: We used cross-sectional data from 57 Demographic and Health Surveys conducted between 2010 and 2018 in LMICs. Descriptive statistics were used to understand the gap in having diarrhoea between the children from poor and non-poor households and across the selected covariates using Fairlie decomposition techniques with multivariable binary logistic regressions at P ¼ 0.05. Results: Of the 57 countries, we found a statistically significant pro-poor odds ratio in only 29 countries, 7 countries showed pro-non-poor inequality and others showed no statistically significant inequality. Among the countries with statistically significant pro-poor inequality, the risk difference was largest in Cameroon (94.61/1000), whereas the largest pro-non-poor risk difference in diarrhoea was widest in Timor-Leste ( 41.80/1000). Important factors responsible for pro-poor inequality varied across countries. The largest contributors to the pro-poor inequalities in having diarrhoea are maternal education, access to media, neighbourhood socio-economic status, place of residence, birth order and maternal age. Conclusion: Diarrhoea remains a major challenge in most LMICs, with a wide range of pro-poor in equalities. These disparities were explained by both compositional and contextual factors, which varied widely across the countries. Thus, multifaceted geographically specific economic alleviation intervention may prove to be a potent approach for addressing the poor and non-poor differentials in the risk of diarrhoea with policies tailored to country-specific risk factors. There is a need for further investigation of factors that drive pro-non-poor inequalities found in 9 of the LMICs.
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    Severe acute malnutrition among under-5 children in low- and middle-income countries: A hierarchical analysis of associated risk factors
    (Elsevier Inc, 2020) Fagbamigbe, A. F.; Kandala, N.-B.; Uthman, O. A.
    Objectives: Malnutrition is one of the main reasons for death among children <5 years of age in low- and middle-income countries (LMICs). It accounts for about one-third of preventable deaths among children. Reduction of malnutrition, especially severe acute malnutrition (SAM), is critical, directly or indirectly, to a targeted decrease in child mortality and improvement in maternal health. It would also help achieve sustainable development goal 2 (improvement of nutrition across the board) and sustainable development goal 3 (ensuring healthy lives and well-being promotion for all at all ages). The aim of this study was to develop and test a model of risk factors associated with SAM among under-5 children in LMICs. Methods: We used 51 recent demographic and health-surveys, cross-sectional, nationally representative data collected between 2010 and 2018 in LMICs. We used multivariable Bayesian logistic multilevel regression models to analyze the association between individual compositional and contextual risk factors associated with SAM. We analyzed information on 532 680 under-5 children (level 1) nested within 55 823 communities (level 2) from 51 LMICs (level 3). Results: The prevalence of SAM ranged from 0.1% in both Guatemala and Peru to 9.9% in Timor-Leste. Male children, infants, low birth weight children, children whose mothers had no formal education, those from poorer households, and those with no access to any media were more likely to have SAM. Additionally, children from rural areas, neighborhoods with high illiteracy and high unemployment rates, and those from countries with high intensity of deprivation and high rural population percentage were more likely to have SAM. Conclusion: Individual compositional and contextual factors were significantly associated with SAM. Attainment of sustainable development goals 1, 4, and 10 will automatically contribute to the eradication of SAM, which in turn leads to the attainment of sustainable development goals 2 and 3. These findings underscore the need to revitalize existing policies and implement interventions to rescue and prevent children from having SAM at the individual, community, and societal levels in LMI.