Niger's child survival success, contributing factors and challenges to sustainability: a retrospective analysis

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dc.contributor.authorBesada, Donelaen_ZA
dc.contributor.authorKerber, Kateen_ZA
dc.contributor.authorLeon, Natalieen_ZA
dc.contributor.authorSanders, Daviden_ZA
dc.contributor.authorDaviaud, Emmanuelleen_ZA
dc.contributor.authorRohde, Sarahen_ZA
dc.contributor.authorRohde, Jonen_ZA
dc.contributor.authorDamme, Wim vanen_ZA
dc.contributor.authorKinney, Maryen_ZA
dc.contributor.authorManda, Samuelen_ZA
dc.contributor.authorOliphant, Nicholas Pen_ZA
dc.contributor.authorHachimou, Fatimaen_ZA
dc.contributor.authorOuedraogo, Adamaen_ZA
dc.contributor.authorGhali, Asma Yarohen_ZA
dc.contributor.authorDoherty, Tanyaen_ZA
dc.date.accessioned2016-03-08T10:55:57Z
dc.date.available2016-03-08T10:55:57Z
dc.date.issued2016en_ZA
dc.description.abstractBACKGROUND: Household surveys undertaken in Niger since 1998 have revealed steady declines in under-5 mortality which have placed the country 'on track' to reach the fourth Millennium Development goal (MDG). This paper explores Niger's mortality and health coverage data for children under-5 years of age up to 2012 to describe trends in high impact interventions and the resulting impact on childhood deaths averted. The sustainability of these trends are also considered. Methods and FINDINGS: Estimates of child mortality using the 2012 Demographic and Health Survey were developed and maternal and child health coverage indicators were calculated over four time periods. Child survival policies and programmes were documented through a review of documents and key informant interviews. The Lives Saved Tool (LiST) was used to estimate the number of child lives saved and identify which interventions had the largest impact on deaths averted. The national mortality rate in children under-5 decreased from 286 child deaths per 1000 live births (95% confidence interval 177 to 394) in the period 1989-1990 to 128 child deaths per 1000 live births in the period 2011-2012 (101 to 155), corresponding to an annual rate of decline of 3.6%, with significant declines taking place after 1998. Improvements in the coverage of maternal and child health interventions between 2006 and 2012 include one and four or more antenatal visits, maternal Fansidar and tetanus toxoid vaccination, measles and DPT3 vaccinations, early and exclusive breastfeeding, oral rehydration salts (ORS) and proportion of children sleeping under an insecticide-treated bed net (ITN). Approximately 26,000 deaths of children under-5 were averted in 2012 due to decreases in stunting rates (27%), increases in ORS (14%), the Hib vaccine (14%), and breastfeeding (11%). Increases in wasting and decreases in vitamin A supplementation negated some of those gains. Care seeking at the community level was responsible for an estimated 7,800 additional deaths averted in 2012. A major policy change occurred in 2006 enabling free health care provision for women and children, and in 2008 the establishment of a community health worker programme. CONCLUSION: Increases in access and coverage of care for mothers and children have averted a considerable number of childhood deaths. The 2006 free health care policy and health post expansion were paramount in reducing barriers to care. However the sustainability of this policy and health service provision is precarious in light of persistently high fertility rates, unpredictable GDP growth, a high dependence on donor support and increasing pressures on government funding.en_ZA
dc.identifier.apacitationBesada, D., Kerber, K., Leon, N., Sanders, D., Daviaud, E., Rohde, S., ... Doherty, T. (2016). Niger's child survival success, contributing factors and challenges to sustainability: a retrospective analysis. <i>PLoS One</i>, http://hdl.handle.net/11427/17576en_ZA
dc.identifier.chicagocitationBesada, Donela, Kate Kerber, Natalie Leon, David Sanders, Emmanuelle Daviaud, Sarah Rohde, Jon Rohde, et al "Niger's child survival success, contributing factors and challenges to sustainability: a retrospective analysis." <i>PLoS One</i> (2016) http://hdl.handle.net/11427/17576en_ZA
dc.identifier.citationBesada, D., Kerber, K., Leon, N., Sanders, D., Daviaud, E., Rohde, S., ... & Oliphant, N. P. (2016). Niger's child survival success, contributing factors and challenges to sustainability: a retrospective analysis. PloS one, 11(1). doi:10.1371/journal.pone.0146945en_ZA
dc.identifier.ris TY - Journal Article AU - Besada, Donela AU - Kerber, Kate AU - Leon, Natalie AU - Sanders, David AU - Daviaud, Emmanuelle AU - Rohde, Sarah AU - Rohde, Jon AU - Damme, Wim van AU - Kinney, Mary AU - Manda, Samuel AU - Oliphant, Nicholas P AU - Hachimou, Fatima AU - Ouedraogo, Adama AU - Ghali, Asma Yaroh AU - Doherty, Tanya AB - BACKGROUND: Household surveys undertaken in Niger since 1998 have revealed steady declines in under-5 mortality which have placed the country 'on track' to reach the fourth Millennium Development goal (MDG). This paper explores Niger's mortality and health coverage data for children under-5 years of age up to 2012 to describe trends in high impact interventions and the resulting impact on childhood deaths averted. The sustainability of these trends are also considered. Methods and FINDINGS: Estimates of child mortality using the 2012 Demographic and Health Survey were developed and maternal and child health coverage indicators were calculated over four time periods. Child survival policies and programmes were documented through a review of documents and key informant interviews. The Lives Saved Tool (LiST) was used to estimate the number of child lives saved and identify which interventions had the largest impact on deaths averted. The national mortality rate in children under-5 decreased from 286 child deaths per 1000 live births (95% confidence interval 177 to 394) in the period 1989-1990 to 128 child deaths per 1000 live births in the period 2011-2012 (101 to 155), corresponding to an annual rate of decline of 3.6%, with significant declines taking place after 1998. Improvements in the coverage of maternal and child health interventions between 2006 and 2012 include one and four or more antenatal visits, maternal Fansidar and tetanus toxoid vaccination, measles and DPT3 vaccinations, early and exclusive breastfeeding, oral rehydration salts (ORS) and proportion of children sleeping under an insecticide-treated bed net (ITN). Approximately 26,000 deaths of children under-5 were averted in 2012 due to decreases in stunting rates (27%), increases in ORS (14%), the Hib vaccine (14%), and breastfeeding (11%). Increases in wasting and decreases in vitamin A supplementation negated some of those gains. Care seeking at the community level was responsible for an estimated 7,800 additional deaths averted in 2012. A major policy change occurred in 2006 enabling free health care provision for women and children, and in 2008 the establishment of a community health worker programme. CONCLUSION: Increases in access and coverage of care for mothers and children have averted a considerable number of childhood deaths. The 2006 free health care policy and health post expansion were paramount in reducing barriers to care. However the sustainability of this policy and health service provision is precarious in light of persistently high fertility rates, unpredictable GDP growth, a high dependence on donor support and increasing pressures on government funding. DA - 2016 DB - OpenUCT DO - 10.1371/journal.pone.0146945 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2016 T1 - Niger's child survival success, contributing factors and challenges to sustainability: a retrospective analysis TI - Niger's child survival success, contributing factors and challenges to sustainability: a retrospective analysis UR - http://hdl.handle.net/11427/17576 ER - en_ZA
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0146945en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/17576
dc.identifier.vancouvercitationBesada D, Kerber K, Leon N, Sanders D, Daviaud E, Rohde S, et al. Niger's child survival success, contributing factors and challenges to sustainability: a retrospective analysis. PLoS One. 2016; http://hdl.handle.net/11427/17576.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentDepartment of Paediatrics and Child Healthen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.en_ZA
dc.rights.holder© 2016 Besada et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherDeath ratesen_ZA
dc.subject.otherChild healthen_ZA
dc.subject.otherChildrenen_ZA
dc.subject.otherHealth care policyen_ZA
dc.subject.otherNigeren_ZA
dc.subject.otherMalariaen_ZA
dc.subject.otherPneumoniaen_ZA
dc.subject.otherAntenatal careen_ZA
dc.titleNiger's child survival success, contributing factors and challenges to sustainability: a retrospective analysisen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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