The sex gap in neonatal mortality and the AIDS epidemic in sub-Saharan Africa

Yaya, Sanni; Diarra, Setou; Mabeu, Marie Christelle; Pongou, Roland

doi:10.1136/bmjgh-2018-000940

Cited by 7 publications

(7 citation statements)

References 14 publications

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“…The NMR among male neonates was 1.6 times higher compared to female neonates as measured by R (Table 2). This finding is consistent with a previous study, which showed that NMR was more prevalent among male children (45). Explanations for higher male neonatal mortality have been suggested in previous studies and hypothesized to be a "male disadvantage" suggesting that male sex appears to be more susceptible to mortality and morbidity, including low Apgar score, intrauterine growth restriction, respiratory failure or prematurity (45)(46)(47).…”

Section: Discussionsupporting

confidence: 92%

Regional variations and socio-economic disparities in neonatal mortality in Angola: a cross-sectional study using demographic and health surveys

Yaya

Zegeye²,

Oladimeji

et al. 2020

Family Practice

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Background Inequalities in neonatal mortality rates (NMRs) in low- and middle-income countries show key disparities at the detriment of disadvantaged population subgroups. There is a lack of scholarly evidence on the extent and reasons for the inequalities in NMRs in Angola. Objective The aim of this study was to assess the socio-economic, place of residence, region and gender inequalities in the NMRs in Angola. Methods The World Health Organization Health Equity Assessment Toolkit software was used to analyse data from the 2015 Angola Demographic and Health Survey. Five equity stratifiers: subnational regions, education, wealth, residence and sex were used to disaggregate NMR inequality. Absolute and relative inequality measures, namely, difference, population attributable fraction (PAF), population attributable risk (PAR) and ratio, were calculated to provide a broader understanding of the inequalities in NMR. Statistical significance was calculated at corresponding 95% uncertainty intervals. Findings We found significant wealth-driven [PAR = −14.16, 95% corresponding interval (CI): −15.12, −13.19], education-related (PAF = −22.5%, 95% CI: −25.93, −19.23), urban–rural (PAF = −14.5%, 95% CI: −16.38, −12.74), sex-based (PAR = −5.6%, 95% CI: −6.17, −5.10) and subnational regional (PAF = −82.2%, 95% CI: −90.14, −74.41) disparities in NMRs, with higher burden among deprived population subgroups. Conclusions High NMRs were found among male neonates and those born to mothers with no formal education, poor mothers and those living in rural areas and the Benguela region. Interventions aimed at reducing NMRs, should be designed with specific focus on disadvantaged subpopulations.

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Section: Discussionsupporting

confidence: 92%

Regional variations and socio-economic disparities in neonatal mortality in Angola: a cross-sectional study using demographic and health surveys

Yaya

Zegeye²,

Oladimeji

et al. 2020

Family Practice

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“…It has been shown that differences in survival between boys and girls exist at least up to the age of 5 years [14]. An excess male child mortality can be explained by biological factors (lower resistance to infection, higher risk of premature birth, difficult labour related to a larger average body size and head circumference), gender discrimination (differential feeding and medical care practices, or response to HIV-related drugs) [22,23]. After adjusting for a range of individual, household and community variables (including age, birth order, household wealth, maternal education but also skilled birth attendance and other factors), the excess male mortality remained significant in several countries in Sub-Saharan Africa [24].…”

Section: Resultsmentioning

confidence: 99%

Socioeconomic factors contributing to under-five mortality in sub-Saharan Africa: a decomposition analysis

et al. 2019

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Background In sub-Saharan Africa, socioeconomic factors such as place of residence, mother’s educational level, or household wealth, are strongly associated with risk factors of under-five mortality (U5M) such as health behavior or exposure to diseases and injuries. The aim of the study was to assess the relative contribution of four known socioeconomic factors to the variability in U5M in sub-Saharan countries. Methods The study was based on birth histories from the Demographic and Health Surveys conducted in 32 sub-Saharan countries in 2010–2016. The relative contribution of sex of the child, place of residence, mother’s educational level, and household wealth to the variability in U5M was assessed using a regression-based decomposition of a Gini-type index. Results The Gini index – measuring the variability in U5M related to the four socioeconomic factors – varied from 0.006 (95%CI: 0.001–0.010) in Liberia 2013 to 0.034 (95%CI: 0.029–0.039) in Côte d’Ivoire 2011/12. The main contributors to the Gini index (with a relative contribution higher than 25%) were different across countries: mother’s educational level in 13 countries, sex of the child in 12 countries, household wealth in 11 countries, and place of residence in 8 countries (in some countries, more than one main contributor was identified). Conclusions Factors related to socioeconomic status exert varied effects on the variability in U5M in sub-Saharan African countries. The findings provide evidence in support of prioritizing intersectoral interventions aiming at improving child survival in all subgroups of a population.

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“…The data were collected from the most recent survey. However, this was a cross-sectional study which cannot be used to indicate causal inference of the association [53,54] between pregnant women's health and TT immunization.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Prevalence and predictors of taking tetanus toxoid vaccine in pregnancy: a cross-sectional study of 8,722 women in Sierra Leone

et al. 2020

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Background: Immunization of women during pregnancy to protect them and their infants against tetanus, pertussis and influenza is recommended by the World health Organization (WHO). However, there is limited information about the coverage rate and associated factors in low-income countries. The aim of this study was to measure the prevalence and predictors of taking tetanus toxoid among pregnant women in Sierra Leone. Methods: This study was based on the fifth round of Multiple Indicator Cluster Survey (MICS 5) conducted in Sierra Leone in 2017. In total 8722 women aged between 15 and 49 years were included in this study. Outcome variable was taking of Tetanus Toxoid vaccination during the last pregnancy. Data were analyzed using cross-tabulation and logistic regression methods. Results: The overall prevalence of receiving TT immunization during women's last pregnancy was 96.3% and that of taking at least two doses was 82.12%. In the regression analysis, women from Mende ethnicity had a 0.48 fold lower chance of being immunized (OR = 0.480, 95% CI = 0.385,0.59768) than those from the other ethnicity. In addition, women who attended at least four ANC visits had higher odds of receiving TT vaccine (OR = 1.919, 95% CI = 1.639, 2.245) compared to those who attended less ANC visits. Stratified by areas, this association was observed in both urban (OR = 2.661, 95% CI = 1.924,3.679) and rural areas (OR = 1.716, 95% CI = 1.430,2.059). Attending at least four ANC visits showed a positive association with receiving at least two doses TT (OR = 2.434, 95% CI = 1.711,3.464) in both urban (OR = 2.815, 95% CI = 1.413,5.610) and rural areas (OR = 2.216, 95% CI = 1.463,3.356) as well. Conclusion: Higher number of ANC visits, mass media exposure and higher wealth quintile increased the odds of receiving TT immunization. In addition, minimum two doses which were identified to reduce neonatal mortality. Therefore, immunization campaigns targeting improved utilization of healthcare and immunization services by women of childbearing age in Sierra Leone are strongly recommended.

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The sex gap in neonatal mortality and the AIDS epidemic in sub-Saharan Africa

Cited by 7 publications

References 14 publications

Regional variations and socio-economic disparities in neonatal mortality in Angola: a cross-sectional study using demographic and health surveys

Regional variations and socio-economic disparities in neonatal mortality in Angola: a cross-sectional study using demographic and health surveys

Socioeconomic factors contributing to under-five mortality in sub-Saharan Africa: a decomposition analysis

Prevalence and predictors of taking tetanus toxoid vaccine in pregnancy: a cross-sectional study of 8,722 women in Sierra Leone

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