The impact of health interventions and programmes on mortality

In Bangladesh, low use of facilities for maternal health services in rural areas has been a critical challenge to the health system in reducing maternal mortality. Health facilities in rural areas operate at less than their capacity due to shortage and sub-optimal performance of service providers. An operations research was conducted to test the feasibility of pay-for-performance (P4P) approach, through which financial incentive was provided to motivate the team of managers, direct and indirect providers, and administrative and support staff of a facility for achieving both quantity and quality targets on maternal health services set for the institution on quarterly basis. Performance of a facility was measured using service statistics and quality assessment reports. An external body with an obstetrician, an anesthesiologist and a pediatrician was formed to assess the facility performance every three months and subsequently incentive was paid to the eligible facility. Performance-based incentive motivated additional efforts which caused to increase service volume remarkably, and the facilities also succeeded in improving quality of services. Performance-based incentive is required until it significantly increases the rate of institutional delivery, a key requirement to reduce maternal mortality.

Concentration of poor health among the deprived and cost restriction to access health care services lead to higher utilization of public health facilities by the poor than the rich. Supply centric public health policy usually not advancing the poor’s health. Thus, for effective health care utilization government should simultaneously address the supply factor and demand barriers. Using data from 3rd round of District Level Health Survey (DLHS-3, 2007-08), we have endeavored to find out the supply factor and demand barriers for antenatal care (ANC) services by women aged 15-49 years. We have focused ANC because it is the best and cost effective strategy to achieve both MDG4 (under-5 mortality) and MDG5 (maternal mortality). Result shows that 55% women did not go for ANC due to demand side barrier of not necessary. On the supply side 24% women could not go for ANC due to too much cost of ANC services. Importance of custom and knowledge barrier decreases with socioeconomic status, but feeling not necessary to demand ANC increases. Result suggests that public health intervention should simultaneous address the supply and demand side barriers for the effective utilization of health care (ANC) services.

The present study attempts to investigate the association between public spending on health and childhood mortality in India; using time-series cross-sectional data from various government sources for the period 1985-2009. Infant and child (age 1 to 4 years) mortality rates were used as the indicators for childhood mortality. Ordinary least squares, generalized least squares and fixed effects regression models were used to investigate the association between public spending on health and childhood mortality. The findings suggest insignificant association between public spending on health and childhood mortality both at the country level and for the EAG states. On the contrary, per capita state income and female literacy were significantly associated with improved childhood survival. Percentage of the population living below the poverty line was significantly associated with infant and child mortality only in the EAG states. The findings call for a number of other measures along with increased public spending on health to reduce infant and child mortality in India.

This study examines the spatial relationship to the maternal-health-care utilization focusing on institutional births which direct related to maternal-mortality.Socio-economically weak states (Empowered Action Group)was studied. Some facility adequacy indices were prepared for the purpose using DLHS-3 data and reliability test found to be good(0.7<alpha<1.0).Inequality measures showed maximum number of districts belongs to UP and Bihar where lowest adequacy of all indices of infrastructures at PHCs. Though very uneven pattern was seen for the adequacy at HSCs. Correlation-matrix showed health personnel adequacy index were highly correlated with physical-infrastructure-index at PHC. Spatial dependence for delivery care captured the better acceptability to describe through several tests of spatial diagnosis over dependents, independents and error term. Some covariates disappeared its influence on independents once spatial-lag parameter incorporated in the OLS model like availability of doctors at PHC, proportion of SC/ST and urban population. Low infrastructure adequacy, distant health facility providing ANC/delivery care and proportion of lowest quintile have significantly reduced the probability of institutional births while receipt of 3or more ANC, connectivity of village to the health center and women literacy have encouraged.

An attempt has been made to explore status of maternal health and utilisation of maternal health care services among maternal death reported households in India and its regions. District Level Household and Facility Survey (2007-08) data reiterates, maternal deaths are significantly high in rural areas especially in high focus Non-North Eastern States. Results show inverse relationship between economic status and maternal deaths. There is wide disparity in maternal mortality ratio within various regions in India with highest as 390 in Assam and lowest as 81 in Kerala per 100000 live births. 56 percent deaths were reported during pregnancy. Contraceptive coverage in households reported maternal deaths is at the low level and moreover in the same household the usage of modern methods of contraception is also low this is clearly indicative of the low coverage of birth spacing methods that exposed women to repeated unwanted births hence, increasing risk of maternal morbidity and mortality.

Cardio-vascular mortality is the flaring global problem. According to WHO, it stood on the top with 29.34 percent in the leading causes of global death. In recent years, promotive and protective health care has been emerging as a major approach throughout the world. This trend is really a convincing convergence of contemporary medicine towards the traditional approaches of Yoga and Ayurveda in preventive cardiology.
Yoga and Ayurveda, the ancient Indian medicine system has several preventive measures to reduce the cardiac mortality. In this study different dynamics of Yoga like various pranayama and Asanas and Ayurvada like Nidan Parivarjan (Elimination of cause), Ahara-Vihar (Food habits and Life style interventions), Aushadhi (Cardio-protective drug) –“Rasona Ksheerpaka” (a preparation of Allium sativum and milk) have been considered. These interventions have been found effective to address the regression of contributing factors of cardio-vascular disease like hypertension, high blood sugar, dyslipidaemia, high uric acid in blood, stress, obesity, smoking and reducing the mortality rate significantly. The outcome of this study revealed a new dimension of integrated approach of Yoga and Ayurvedic interventions in preventive cardiology and reducing the mortality of cardio-vascular disease.

The Impact of Health Intervention and Programmes on Mortality - A Case of Early Age Mortality in Nepal

Karki Yagya B.*, Hendrikus Raaijmakers** & Asha Pun***
*Population, Health & Development (PHD) Group, **Program Chief, Child Health & Survival and ***MNH Specialist, UNICEF, Nepal

Neonatal mortality rate (NNR) has declined slowly in Nepal. Between 2001 and 2011, post-neonatal (PNN) mortality fell by 50% (26 to 13), whereas the neonatal mortality was reduced by only 15% (39 to 33). During the last 5-year period (2006-2010) NNR didn't decline while PNN declined by 13%. Hence, an increasing proportion of child deaths are in the neonatal period; 61% of all deaths in children under 5 took place in the neonatal period. Nepal Government with technical and financial support from the private sector, NGOs and External Development Partners has attempted to reduce NNR by piloting CB-NCP in 10 districts in 2009 and 2010. Analysis of Nepal Demographic and Health Survey (NDHS) 2011 data shows that Community-Based Newborn Care Program (CB-NCP) has worked as the newborn care practices have improved and NNR in intervention areas is about half (20 per 1000 live births) the level than that of the remaining areas (39) of Nepal although nationally no decline was observed in 2011 compared to 2006 (33).

China has experienced an extraordinary mortality transition over the last 60 years. However, mortality decline has not been consistent and uniform across all ages. Changes in health interventions and programs have particularly heavily affected health and mortality at old ages. This paper examines trends in China’s old-age mortality and its underlying determinants. Three stages of old-age mortality changes can be identified. Sharp fall in old-age mortality from the early 1950s to the early 1970s, stagnation in mortality improvement during the 1980s-1990s, and large decline again from 2000 to 2010. Life expectancy in China was rising overall, but perceived health expectancy at age 60 had stalled between 1992 to 2000. The last 10 years have seen marked improvement in both life expectancy and perceived health expectancy. Mortality change has been more evident for females than for males. There are reflections of social, economic and medical policy changes in each of the phases, which may have different impacts on different population subgroups. Deterioration in health at old ages was observed as a consequence of the economic and medical reform, while old-age mortality improvement is largely a result of government efforts in establishing urban and rural medical insurance systems.

Survival status of children is one of the indicators of socio-economic development of any given country. A number of developing countries are, however, unable to tackle causes of child morbidity and mortality due to poor public health measures and lack of access to health care facilities. The MDG4 set by the UN is to reduce child mortality level of 1990 by two-third by 2015. The main objective of this study is to identify determinants of child mortality in Ethiopia, and assess if the aforementioned goal is attainable using three rounds of the Demographic and Health Surveys conducted in 2000, 2005 and 2011. Data were analyzed using tabular and graphical methods, and an event history logistic regression model is fitted to identify factors associated with child survival. Results of the study reveal that Ethiopia is on track to achieve the child mortality goal but requires making extra efforts to reduce the excessive neonatal mortality. Significant differences in child mortality still prevail across the regions though the Health Extension Workers (HEWs) provide vaccination and treat child illnesses in rural Ethiopia. Enhancing the capacity of HEWs to manage obstetric care and ANC would ensure higher chances of survival of children in the future.

The study set out to establish the determinants of prophylaxis uptake against malaria among pregnant women in central Uganda.
A sample of 824 women was extracted from the main dataset of UDHS 2006 for further analysis. Univariate, bivariate and multivariate analyses were used. From bivariate analysis, the independent factors that were significantly associated with prophylaxis uptake against malaria included education level, wealth index, ownership and type of bed net used, antenatal visits and residence. From multivariate analysis, the significant determinants of prophylaxis uptake included education level and antenatal visits; where pregnant women with secondary+ education were more likely to use prophylaxis and pregnant women who attended antenatal were also more likely to use prophylaxis.We recommend that improving information education and communication strategy particularly targeting pregnant women with no education who lack knowledge on the use of prophylaxis against malaria.