The impact of health interventions and programmes on mortality

Northern Nigeria’s infant and child mortality rates have been stagnant or rising since 2005. In 2009 we became part of a partnership program to improve maternal, newborn, infant and child care in four Northern Nigeria states. Control Local Government Areas received less-intense statewide policy changes, while the intervention zones received these state policies plus integrated interventions at primary health care posts and development of a community-based service delivery (CBSD). We assessed changes in maternal, newborn, and child health (MNCH) care and services among women with births in the previous five years by comparing data from surveys of 6,345 women in 2009 and 3,320 women in 2011. Chi-square and t-tests document significant improvements in several maternal newborn, infant, and childcare practices. We found that pregnant women with antenatal care visit during the most recent pregnancy increased from 25% to 46%, 58% and 62% in the control, low intensity and high intensity areas, respectively. In general, the greatest improvements in MNCH care are seen among women in the communities with more interactions and potentially more intense CBSD activities. Regressions showed the differential impact of these interventions by social and economic vulnerability, with less impact in the most vulnerable communities.

“Preventable” hospitalizations have been proposed as indicators of health plan performance. Preventable hospitalizations present a broader view and refer to those admissions 'resulting from diseases preventable through population-based health promotion strategies, eg. alcohol-related conditions' and those 'avoidable through injury prevention (eg. road traffic accidents). Ambulatory Care-Sensitive Conditions Hospitalizations (ACSCs) analyses may also be used to identify or evaluate interventions that are likely to be effective in fulfilling health needs. The objective of this study is to know the composition and the tendency among the elderly and the ACSC and to correlate this to the coverage and access to primary care services in Rio de Janeiro, Brazil, between 2000 and 2010. We observed the tendency of reduced ACSC mainly of the chronic lung diseases during this period. We found a high correlation between the interventions in elderly primary care and the decrease of ACSC, what indicates effectiveness of the health program. The elderly men have more risk to ACSC than women. The results show that the study of ACSC is relevant for monitoring the performance of the health system with regard to improving the quality of life for elderly people.

Childhood Nutrition Status of Indonesia is far worse than neighboring countries such as Malaysia and Thailand. At the same time there are also problems of over nutrition (overweight) in Indonesia. A panel data of parents and children who are join nutrition education at “Taman Pintar”, Yogjakarta, Indonesia in 2011 and 2012 and it’s control used for this paper. The method analysis is Different and Different

Parents who attend nutrition educational program, their knowledge on necessary nutritional components in the daily child diet higher than parents who do not get the nutrition education, for vegetables significantly increased by 10% and for protein increased by 15%. The psychological, mental, emotional parents’ who attend nutrition education program shows some encouraging and very conducive for holistic development of the child.

Programs tend to increase the frequency of eating 5 times a week vegetables consumption of the child with vegetable consumption very low before the program to 13% and reduced the consumption of fast food. In addition, nutrition education programs also have a positive impact on the development of children in terms of concentration, socialization and cheerfulness.

Objectives: To describe cholera outbreak trends; show geographical distribution of cholera cases; describe a new cholera communication strategy; and show that the new strategy protects the community from cholera in subsequent outbreaks.

Methods: We reviewed case reports from facilities within KHDSS and samples were sent for laboratory confirmation. We performed GIS spatial analysis on the data showing the distribution of cases. Cholera hotspot areas were identified for intervention. Cholera communication strategy focusing on empowering the community to realize unhygienic conditions of water, food, poor sanitation and personal hygiene was introduced and its impact assessed in subsequent outbreaks.

Results: Suspected cases were 125 between June 2009 and February 2010. The positives were (43%), negatives (47%) and Epi-linked (10%). In the subsequent outbreak between April-May 2010, we observed 90 suspected cases, (9%) positives, (4%) negatives, (81%) epi-linked and (6%) samples were not collected. No cholera cases were reported in the cholera hotspot areas.

Conclusion: Cases of cholera declined with subsequent outbreaks and no case was reported in the hotspot areas. Our intervention worked well suggesting a replicable approach in other epidemic areas.

We examine the effect of health reform in 1995 in Taiwan on health transition among the elderly Taiwanese, including functioning, disability and death by employing a nationally representative longitudinal survey, the “Survey of Health and Living Status of the Middle Aged and Elderly in Taiwan” for analyses. This study ran hazard models over 3 to 4 years to analyze changes from no physical function problem to having difficulty in physical functioning, no ADL/IADL problem to disability, and alive to dead. We found the higher-education benefited from national health insurance (NHI) more than the lower-education to get better mortality outcome. Because the higher-education were more likely to know when the new technology/medicine were available and covered by NHI. As for disability and physical functioning, our study showed that NHI helped to eliminate the income gap by allowing the lower income groups to have better access to health care after health reform.

Efforts at controlling vaccine preventable childhood killer diseases (VPCKDs) in Nigeria; have not yielded desired results. This is partly attributable to macro level policy formulation without recourse to spatial peculiarities; hence this study which examined their spatio-temporal patterns of VPCKDs in Osun State, Nigeria. Primary and secondary data were used. The primary data were obtained from questionnaire on households and in-depth interview with head of the State’s immunisation programme and selected immunization centres. Multi-stage sampling procedure was used to select 200 respondents to the questionnaire. The main secondary data used were records of the monthly reported cases of the diseases (diphtheria, measles, pertussis, poliomyelitis, tetanus and tuberculosis) from the 30 LGAs in the State between 2001and 2010. Results show a significant temporal variation in occurrence (measles, F=25868.49, p<0.05; pertussis, F=681.30, p<0.05; tetanus, F=186.66, p<0.05; tuberculosis, F=63.86, p<0.05; and polio, F=24.13, p<0.05. Also, there exists spatial variation in occurrence of the diseases; measles (F=154866.36, p<0.05; pertussis, F=3750.65, p<0.05; tetanus, F=1001.83, p<0.05; tuberculosis, F=261.70, p<0.05; polio, F=88.39, p<0.05 and diphtheria, F=19.68, p<0.05). Hence, the need to factor spatial peculiarities into control

Vaccination policies in low-income countries assume that vaccines have specific effects by preventing targeted infections and do nothing else. In the disease-specific model, policy and overall impact assessment can be based on assessment of specific immune responses/clinical protection and disease-burden. Once the disease is eradicated it becomes cost-effective to stop vaccination. These assumptions were never tested.

An increasing number of observational studies and randomised trials indicate that all routine vaccinations have non-specific effects (NSE) on morbidity/mortality not explained by specific prevention. A review of evidence related to BCG, DTP, OPV and measles vaccine suggests these generalisations: First, NSEs are more important for survival than the specific effects. Second, live vaccines have beneficial effects whereas inactivated vaccines may have detrimental effects. Third, the most recent vaccination has the strongest effect on survival and combination and sequence of vaccinations are therefore important. Fourth, NSEs are often sex-differential. Firth, vaccines may interact with immune-enhancing interventions like micronutrients. Sixth, eradicating the disease and eliminating a live vaccine may cost more lives than those saved by eradication campaigns.

Abstract
Infant and childhood mortality are good indicators of social development of a nation. The developed nations of the world are having infant and childhood mortality of below 5/1000 and 10/1000 live births respectively. From the National Demographic and Health Survey of 2008 Nigeria has an infant mortality rate of 75/1000 and childhood mortality of 88/1000 live births. These are very high by world standard. The Federal government of Nigeria through the Population policy and also the Health policy targeted at reducing the infant mortality rate to 35/1000 and childhood mortality rate to 45/1000 and maternal mortality to 125/100000 births. If the overall objective of providing effective, efficient, quality, accessible and affordable healthcare services that will improve the health status of Nigerians and achieve health related Millennium Development Goals is to be met, then there is the need for proper re-examination and overhauling of the functioning and operations of the Primary Healthcare system. The paper is of the view that IMR and CMR can be drastically reduced if the philosophy and objectives of PHC system are adhered to, most especially in our rural communities. Social Action Model is adopted as theoretical frame while the method consists of questionnaire, FGD and Key Informant interview..

Self-reported morbidity i.e. measure of incidence of disease based on reported sickness has an element of subjectivity. Unlike morbidity, mortality is an objective measure based on “external assessment of health”. In India, there are evidences of regions where the reported morbidity is higher, yet the mortality is low and vice versa. Motivated from this opposing observation in morbidity and mortality and from the fact that there is a dearth of literature on exploring the relation between morbidity and mortality in Indian context, this paper studies the difference between morbidity and mortality for Indian States. The study conceptualizes Mortality–Morbidity–Gap Index (MMGI) and justifies the measure through an axiomatic characterization. An empirical illustration is carried out ranking the States of India as per MMGI using data from National Sample Survey. The study also investigates the determinants of MMGI by considering State’s income, education, urbanization, health infrastructure, and policy variables.

This study examined the illness or diseases affecting people living in South Africa. In this study we focus on the dependent variables of health status and whether subjects suffered from illness/sickness. The study focused on respondent’s age 15-49 years, corresponding to a total of 55,384 people composed of 25,859 males and 29,525 females. Among this population, 5,935 people suffered from illness/injury, including 2,469 (41.6%) males and 3,466 (58.4%) females. This article provides weighted multivariate estimates of illness by province, in association with background characteristics of the target population, and selected socioeconomic and demographic variables. Tuberculosis (TB) is the second most common cause of illness/injury only in the provinces of Kwazulu Natal (9.1%), North West (5.4%) and Limpopo (4.2%). People who are not married have 1.2 times greater chance than those currently married to suffer from illnesses/injuries. Those with non-living spouses are 1.09 times more likely than the others to suffer from illness/injury. This study concluded that rapid action is needed to fight illness/diseases to produce a healthy population. Therefore, follow-up care and special consideration is urgently needed for the weaker provinces like KwaZulu Natal.