Effect of health systems context on infant and child mortality in sub-Saharan Africa from 1995 to 2015, a longitudinal cohort analysis

Abstract Each year, > 3 million children die in sub-Saharan Africa before their fifth birthday. Most deaths are preventable or avoidable through interventions delivered in the primary healthcare system. However, evidence regarding the impact of health system characteristics on child survival is s...

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Autores principales:	Ryan A. Simmons, Rebecca Anthopolos, Wendy Prudhomme O’Meara
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/f6836898bd9e4a40a3951ffdb84a5951
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spelling	oai:doaj.org-article:f6836898bd9e4a40a3951ffdb84a59512021-12-02T15:08:10ZEffect of health systems context on infant and child mortality in sub-Saharan Africa from 1995 to 2015, a longitudinal cohort analysis10.1038/s41598-021-95886-82045-2322https://doaj.org/article/f6836898bd9e4a40a3951ffdb84a59512021-08-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-95886-8https://doaj.org/toc/2045-2322Abstract Each year, > 3 million children die in sub-Saharan Africa before their fifth birthday. Most deaths are preventable or avoidable through interventions delivered in the primary healthcare system. However, evidence regarding the impact of health system characteristics on child survival is sparse. We assembled a retrospective cohort of > 250,000 children in seven countries in sub-Saharan Africa. We described their health service context at the subnational level using standardized surveys and employed parametric survival models to estimate the effect of three major domains of health services—quality, access, and cost—on infant and child survival, after adjusting for child, maternal, and household characteristics. Between 1995 and 2015 we observed 13,629 deaths in infants and 5149 in children. In fully-adjusted models, the largest effect sizes were related to fees for services. Immunization fees were correlated with poor child survival (HR = 1.20, 95% CI 1.12–1.28) while delivery fees were correlated with poor infant survival (HR = 1.11, 95% CI 1.01–1.21). Accessibility of facilities and greater concentrations of private facilities were associated with improved infant and child survival. The proportion of facilities with a doctor was correlated with increased risk of death in children and infants. We quantify the impact of health service environment on survival up to five years of age. Reducing health care costs and improving the accessibility of health facilities should remain a priority for improving infant and child survival. In the absence of these fundamental investments, more specialized interventions may not achieve their desired impact.Ryan A. SimmonsRebecca AnthopolosWendy Prudhomme O’MearaNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-10 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Ryan A. Simmons Rebecca Anthopolos Wendy Prudhomme O’Meara Effect of health systems context on infant and child mortality in sub-Saharan Africa from 1995 to 2015, a longitudinal cohort analysis
description	Abstract Each year, > 3 million children die in sub-Saharan Africa before their fifth birthday. Most deaths are preventable or avoidable through interventions delivered in the primary healthcare system. However, evidence regarding the impact of health system characteristics on child survival is sparse. We assembled a retrospective cohort of > 250,000 children in seven countries in sub-Saharan Africa. We described their health service context at the subnational level using standardized surveys and employed parametric survival models to estimate the effect of three major domains of health services—quality, access, and cost—on infant and child survival, after adjusting for child, maternal, and household characteristics. Between 1995 and 2015 we observed 13,629 deaths in infants and 5149 in children. In fully-adjusted models, the largest effect sizes were related to fees for services. Immunization fees were correlated with poor child survival (HR = 1.20, 95% CI 1.12–1.28) while delivery fees were correlated with poor infant survival (HR = 1.11, 95% CI 1.01–1.21). Accessibility of facilities and greater concentrations of private facilities were associated with improved infant and child survival. The proportion of facilities with a doctor was correlated with increased risk of death in children and infants. We quantify the impact of health service environment on survival up to five years of age. Reducing health care costs and improving the accessibility of health facilities should remain a priority for improving infant and child survival. In the absence of these fundamental investments, more specialized interventions may not achieve their desired impact.
format	article
author	Ryan A. Simmons Rebecca Anthopolos Wendy Prudhomme O’Meara
author_facet	Ryan A. Simmons Rebecca Anthopolos Wendy Prudhomme O’Meara
author_sort	Ryan A. Simmons
title	Effect of health systems context on infant and child mortality in sub-Saharan Africa from 1995 to 2015, a longitudinal cohort analysis
title_short	Effect of health systems context on infant and child mortality in sub-Saharan Africa from 1995 to 2015, a longitudinal cohort analysis
title_full	Effect of health systems context on infant and child mortality in sub-Saharan Africa from 1995 to 2015, a longitudinal cohort analysis
title_fullStr	Effect of health systems context on infant and child mortality in sub-Saharan Africa from 1995 to 2015, a longitudinal cohort analysis
title_full_unstemmed	Effect of health systems context on infant and child mortality in sub-Saharan Africa from 1995 to 2015, a longitudinal cohort analysis
title_sort	effect of health systems context on infant and child mortality in sub-saharan africa from 1995 to 2015, a longitudinal cohort analysis
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/f6836898bd9e4a40a3951ffdb84a5951
work_keys_str_mv	AT ryanasimmons effectofhealthsystemscontextoninfantandchildmortalityinsubsaharanafricafrom1995to2015alongitudinalcohortanalysis AT rebeccaanthopolos effectofhealthsystemscontextoninfantandchildmortalityinsubsaharanafricafrom1995to2015alongitudinalcohortanalysis AT wendyprudhommeomeara effectofhealthsystemscontextoninfantandchildmortalityinsubsaharanafricafrom1995to2015alongitudinalcohortanalysis
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Effect of health systems context on infant and child mortality in sub-Saharan Africa from 1995 to 2015, a longitudinal cohort analysis

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