A look back at the millenium development goal of reducing #maternal mortality - studies from 2004 and 2009 - African Population Studies Vol.19 No.12 & Journal of Postgraduate Medicine Vol.55 No.1

The Guardian recently published an article on a new report compiled by a number of health organizations such as WaterAID and WHO that calls for action on water sanitation and hygiene care that could greatly reduce maternal deaths in Africa. The article notes that goal number 5 of the United Nation's millenium goals between 1990 and 2015 was to reduce the maternal mortality ratio. The Guardian notes that although rates have been improving in some countries, low-income and middle-income countries have yet to succeed in reaching this goal. The Guardian notes that among these countries are Tanzania and South Sudan.

Several articles on Bioline have discussed this issue in relation to different countries. Among them is an article from ten years ago in African Population Studies vol.19 no.12 named: "Maternal and Child Health among the Urban Poor in Nairobi, Kenya" by Monica Magadi. This study takes a look at the health care provided to infants and their mothers in the slums of Nairobi, and Kenya. Magadi notes that although it is important to consider the care and quality of services provided to the infants and their mothers, their overall health prior is equally as important. Unfortunately, many of these deaths occur as a direct result of diseases and malnutrition from lack of services and necessities such as food, shelter, health care, nutrition and water sanitation. Diarrhea is also prevalent in Nairobi, especially for people living in slums. Only 53 per cent of slum residents have access to safe drinking water. In the three major slums in Nairobi, it was reported that most water does not go directly to their houses but instead is purchased from informal traders or taken from communal water points. These conditions make for poor health of both the children and their mothers, and Magadi notes that they require urgent attention.

Another article, "An autopsy study of maternal mortality: A tertiary healthcare perspective" by Panchabhai et al. in the Journal of Postgraduate Medicine vol.55 no.1, discusses this millenium goal in relation to India. Panchabhai et al. note that many maternal deaths in India are attributable to sepsis, infection and hemorrhage. This study evaluates the maternal deaths that occurred between January 1998 to December 2006. Tuberculosis, malaria and meningitis were amongst the cases of deaths.

These articles highlight the need for action to be taken in preventing more maternal deaths, particularly in developing countries.

You can find more articles on Bioline on maternal mortality here.

WHO says ageing policies needed globally - How is the 2002 WHO active ageing framework applicable to Zambia? - African Population Studies Vol.28 No.3

A recent news release from the World Health Organization that came out on Nov.6 says that there is a need for effective strategies to combat chronic illnesses associated with aging, as there is an "ageing world population."

According to WHO, policies are needed globally, not just for developing countries. One of the recent issues from African Population Studies looks at a policy framework on aging published by WHO in April 2002. This is discussed in the article "Determinants of active ageing in Zambia" by Christopher Chabila Mapoma in vol.28 no.3. The study addresses the need to see if this type of policy framework works in developing countries, specifically Zambia. Its aim is to find out which determinants of the active ageing framework apply not only to Zambia, but the continent of Africa as a whole. The study also examines how HIV/AIDS affects active aging. Active aging is defined by WHO as "the process of optimizing opportunities for health, participation and security in order to enhance quality of life as people age." Mapoma mentions that little research has been done on the importance and contribution of the "active ageing" concept in Africa.

For this study, researchers surveyed participants ages 60 years and older in four seniors homes in the Matero, Kandiana, Maramba, Mitanda and Chibolya neighbourhoods of the Lusaka, Sesheke, Livinstone, Ndola and Mufulira districts. 41.2 per cent of the participants were men, and 58.8 percent were females. The survey asked questions pertaining to socioeconomics, HIV/AIDS, and behavioural and health/functional indicators of active aging. The responses to the questions of Behavioural and Personal determinants were measured using indicators such as feeling hopeless, useless, unhappy or lonely. Health and functional determinants were measured using indicators toward yes or no questions of being able to squat, ability to walk freely, and ability to clean their own house. Economic determinants were measured using indicators toward questions such as: have you worked in the past 12 months, having opportunities for work, and having a steady flow of income.

In this study, Mapoma found that there were more respondents from urban areas rather than rural areas. 15.8 percent were found to have received higher education, 32 percent were reported to have never attended school, and 52 percent had received primary education. HIV/AIDS was included as a determinant of active aging specifically for Zambia among other factors such as gender, residence, health and physical environment because of the effects of taking care of children who had lost their parents to HIV/AIDS. When comparing residents who live in urban areas to residents who live in rural areas, Mapoma found that residents in urban areas participated in community activities more, are more self-fulfilled and more independent. Monthly income was also linked on a respondent's ability to participate and their independence. HIV/AIDS was also found to affect participation.

The study concluded that HIV/AIDS has a long-term effect on active aging, "feeling hopeless/useless" was a personal/behavioural factor in active aging. The study also indicated that having friends and socializing contributed to the probability of aging actively. The study further concluded that the 2002 WHO Active Ageing Framework is applicable to Zambia but only to a certain extent, as it overlooks HIV/AIDS, which is a factor that greatly affects the country.

Esha Homenauth - A Student Perspective: Determinants of Under-five Mortality in Nigeria

Infant mortality has declined globally by 2.2% between 1990 and 2010,(Rajaratnam et al. 2010), but still falls short of the estimated 4.4% needed to achieve the 4th Millennium Development Goal (MDG 4). Nigeria, the largest country in West Africa, accounted for 12% of the global under-five mortality (U5M) in 2008 (UNICEF, 2010). An unusual trend in U5M decline exists in Nigeria as a result of inconsistencies in the data available for analyses. Currently, the rate of U5M in Nigeria is far behind the decline rate of 11.0% per year needed to acquire the MGD4 in West and Central Africa.

Interventions that target child health need to be efficient in prioritizing scarce resources. A study conducted by Akinyemi et al., published in the African Population Studies Vol 27, No.1, addressed the trends in U5M determinants in Nigeria and determined how the independent contribution of these determinants influenced changes in under-five mortality risks. In this study, a re-analysis of representative sample data collected during the Nigerian Demographic and Health Surveys (NDHS) of 1990, 1999, 2003 and 2008 was done. Eligible women between the ages of 15-49 years in selected households were interviewed. They were asked questions about their summary (number of children born and survived)and detailed reproductive history (sex and date of every live birth, survival status at time of interview, current age of surviving children and age at death).

Results from this study indicated that there was an increase in U5M deaths between 1990 - 2003, but later reduced in 2003-2008. Greater reductions however, were observed in mortality during age 1-4 years than during infancy (0-11 months). A number of variables were observed to have varying degrees of influence on U5M risk. Improvements in the level of maternal and paternal education (through the introduction of universal basic education) was observed to be a significant indicator in the decline of infant mortality. Improvements in antenatal care, skilled delivery, contraceptive use and tetanus toxoid injection during pregnancy were observed to improve U5M mortality risk, however, little change has been observed in these areas of maternal health between 1990 - 2008; largely as a result of population expansion while the number of health facilities and personnel remain unchanged. Improvements in childhood vaccination and oral rehydration therapy has also resulted in a decline in infant mortality. Reduced access to potable drinking water and toilet facilities were observed to increase the risks of under-five deaths.

This study was successful in demonstrating that the effect of changes on mortality risk is proportional to the magnitude of the changes in the determinants. Reduction in U5M risk requires a combination of factors such as maternal education, antenatal care, childhood vaccinations, improvements in household environmental health and birth spacing.

From the perspective of a Health Studies student, this study provides important policy implications for Public Health. Improvements in female education, behavioural/health-related, household environmental health factors and birth practices will result in a reduction in under-five mortality. Promoting birth space is imperative country-wide, as well as improvements in the quality of maternal and child health services. With Bioline International providing open access to articles from this journal, important discussions about the issue of under-five mortality can be stimulated, and relevant interventions can be implicated. As mentioned, disparities in under-five mortality trends in Nigeria exists as a result of insufficient data. Interventions that target improvements in collection of data and analysis is important such that policy implications can be made and resources can be efficiently targeted.

Akinyemi, J.O., Bamgboye, E.A., Ayeni, O.(2013)New trends in under-five mortality determinants and their effects on child survival in Nigeria: A review of childhood mortality data from 1990-2008. African Population Studies, 27(1): 25-42

Did you know...

Did you know that parent absenteeism affects whether or not a child completes school and whether or not they engage in risky behaviour?

Vol.27 No.1 of African Population Studies includes "Parent absenteeism and adolescent work in South Africa: An analysis of the levels and determinants of adolescents who work 10 or more hours a week" by Nicole De Wet. This study examines the correlation between youth (ages 10-17) in the work force and if parent absenteeism is a contributing factor.

The article provides background information on why youth join the workforce as opposed to continuing their education. The study also yields some interesting results: 38.7% of adolescents in South Africa have one parent absent from their household, and 2% of youth who have at least one absent parent are not enrolled in school. 

You can find the complete study and other articles from this issue here.

Featured Issue: African Population Studies Vol.26 No.2

Vol.26 no.2 of African Population Studies has been updated on Bioline. This issue features a number of articles, including "School enrollment in the Democratic Republic of the Congo: family economic well-being, gender, and place of residence" by Mabika & Shapiro. 
This study looks at how the enrolment of children in Democractic Republic of the Congo in schools is affected by the demographics of children's families. The study also examines how political and economic issues experienced by the country affected enrolment at those times. Qualitative data from 1999 was used to examine school enrolments of youth 6 to 24 years of age.

For the results of this study and other articles from this issue, go to: 
http://www.bioline.org.br/titles?id=ep&year=2012&vol=26&num=02&keys=v26n2

Featured Issue: African Population Studies Vol.26 No.1

Nairobi, Kenya

Today we will be featuring an article from vol.26 no.1 of African Population Studies.

We are featuring African Population Studies on blog for the very first time! 

African Population Studies is a journal published by Union for African Population Studies. It focuses on issues relating to population and demographics that affect Africa. 
For more information on this journal, visit the Union for African Population Studies website: http://www.uaps-uepa.org/home/

The article, "Under-five mortality differentials in urban East Africa: a study of three capital cities" by Gideon Rutaremwa explores the differences in under-five mortality rates in three different East Africa cites: Nairobi, Dar-es Salaam and Kampala. Data was analyzed by a count-data regression model to understand the differences in relevant issues affecting under-five mortality rates.

The results indicate that Nairobi experiences lower mortality rates than the other two cities, and the overall study recommends that living conditions and the affects of these conditions should be examined in future studies.

For the complete article and other articles from this issue, go to: http://www.bioline.org.br/titles?id=ep&year=2012&vol=26&num=01&keys=v26n1