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What the GDHS data set is saying about Child Survival

What the GDHS data set is saying about Child Survival. By Prof NNN Nsowah-Nuamah on behalf of the Infant and Child Mortality Working Group. Statement of the problem. DHS reported an increase in Under five and Infant Mortality Rates in 2003 compared to the 1998 levels. Questions Arising.

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What the GDHS data set is saying about Child Survival

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  1. What the GDHS data set is saying about Child Survival By Prof NNN Nsowah-Nuamah on behalf of the Infant and Child Mortality Working Group

  2. Statement of the problem • DHS reported an increase in Under five and Infant Mortality Rates in 2003 compared to the 1998 levels

  3. Questions Arising • Are these increases significant? • Why have IMR and U5MR increased (or not decreased) in spite of investments in Child Health programmes? • What is accounting for this? • What is happening to the Inequalities in Child Health outcomes? • What are the policy and programme implications?

  4. Methodology • Reviewed Literature • Developed Conceptual Framework • Analyzed GDHS Data (1988 - 2003)

  5. Conceptual framework • Mosley-Chen model • To determine distal and proximal determinants of child mortality • Child Survival Pathway Model • A dynamic model that links the determinants to the pathway of child survival • Demonstrates the differential and cumulative effects of the proximal determinants along the child survival pathway

  6. Findings-Under five Mortality Rates Even though there has been an increase over the four rounds, this increase is not statistically significant. • (GRAPH without figures describing in trend under-five)

  7. Findings • Under-five Mortality Rates • Regional Differences still exist • Big shifts in some areas • Upper East

  8. Findings • Under-five Mortality Rates • Rural-Urban Differences still exist • Graph of Rural-Urban Trends in U5 • Rural levels are still higher than urban levels • But the rural-urban gap is narrowing because of greater worsening of urban U5MR

  9. Composition of U5MR • Graph of U5MR CMR and IMR trends (1988 – 2003) • National CMR did not change (Description of Graph)

  10. Composition of U5MR • Regional CMR • 4 out of 10 regions recorded worse CMR (Insert and Describe Amanua’s table) • Inequalities between regions decreased • Ranking

  11. CMR • Rural-Urban CMR • Urban CMR worse than rural CMR • Urban CMR worsened • Rural CMR improved

  12. Infant Mortality Rates • National IMR worsened • Regional IMR has 5 out of 10 regions worsened ( Show Ammanuah’s table) • Regional Ranks changed ( Show Ammanuah’s table)

  13. Infant Mortality Rates • Rural-Urban • Both Rural and Urban IMR worsened • Rural IMR higher than Urban IMR • Rural Urban difference in IMR narrowing (Show graph)

  14. Composition of IMR • Graph of Neonatal and Post Neonatal

  15. Post Neonatal • National Post Neonatal improved

  16. Neonatal • Nationally, Neonatal Mortality worsened • 52% of U5M is in the Neonatal period

  17. Infant Mortality Rate • Neo and Post Neonatal • 50.2 % of Under-five mortality is in the Neonatal period. • 80% of neonatal deaths takes place in the first week of life • Out of this 50% by day one • (Pie Chart of Contributions of death-bands) • Cumulative Graph Day (1, 7, 28, 1 year, 5 years) • Trend analysis of neonatal contribution by the 4 rounds.

  18. Maternal Factors Environmental contamination Nutrient availability Injuries Disease Control Social Economic Biological Environment Neonatal Infant Under five Risk of Disease

  19. Details of the problem Gains in the post neonatal period but losses at early neonatal period which resulted in plateau in gains of Under-five mortality rates. Under-five decomposed into child and infant- shows that infant has increased and child has only declined marginally. Then when IMR is decomposed into neonatal and post neonatal- it shows that post neonatal has declined whilst neonatal has increased leading to IMR increasing. Then when neonatal is decomposed into early and late neonatal- it shows that (Graph of infant broken into early and lateneo-DHS rounds by rates)

  20. Conclusion-1 • Health sector has made gains in the post-neonatal but losses in the early neonatal affecting the overall effect on Under five mortality rate • A need to re-look closely at safe mother hood issues and early neonatal care.

  21. Regional Distributions of under-five and other mortality bands. • Show graphs of U5MR by region • Epimap? (line-graph trend over 4 rounds) To show which regions have increased and which have decreased over time. • There are differences in the changes in the rates within each region for the different death bands. • Rural Urban patterns

  22. Conclusion 2- Regional Differences All regions worsened in early neonatal rates between 1988 to 2003. (Changes in ranking)

  23. Regional variation by Variables (Describe) • Trends in age bands for regions • Policy implications: Specific Regional Targeting • e.g. Volta biggest difference therefore more attention needed • FP • Perinatal issues • Trends in age bands for rural urban • Policy implications: Trend national picture • e.g. urbanization is a problem and blanket targeting is now inappropriate.

  24. Overall conclusions/policy • Worsening in health but reducing Rural-Urban inequalities- the Inequality paradoxs • - No major gains in rural areas but marked losses in urban areas • Regional approach to programming and resource allocation • Revisit targeting strategies • Strengthen Early neonatal care in Safe mother

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