Applying an equity lens to child health and mortality: more of the same is not enough

Victora, Cesar G; Wagstaff, Adam; Schellenberg, Joanna; Gwatkin, Davidson R.; Claeson, Mariam; Habicht, Jean Pierre

doi:10.1016/s0140-6736(03)13917-7

Cited by 619 publications

(491 citation statements)

References 16 publications

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“…Within child survival intervention strategies, equity must be made a priority and tools to ensure accountability at national and international levels must be developed (Victora et al, 2003).…”

Section: Resultsmentioning

confidence: 99%

Iron deficiency and anemia: disparity exists between children in American Samoa and children living within the US

2007

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Background/Objectives: Healthy People 2010 emphasizes elimination of health disparity and improvements in anemia and iron deficiency (ID). The study purpose was to (1) determine the prevalence of anemia, ID and ID anemia (IDA) in children living in American Samoa and (2) compare the prevalence to that found in children living in the United States. Subjects/Methods: A total of 211 children from American Samoa, aged 1-5 years of age, participated in this cross-sectional study. Prevalence of anemia, ID and IDA were determined and comparison made using data obtained from children living in the United States. Anemia was diagnosed as hemoglobin (Hb) o110.0 g/l, ID as erythrocyte protoporphyrin (EP) 470 mmol/mol heme and IDA as Hb o110.0 g/l and EP 470 mmol/mol heme. Results: Anemia, ID and IDA prevalence was 33, 70 and 33%, respectively. The results of children from the United States were as follows: anemia, 9%; ID, 10% and IDA, 2%. Within American Samoan children, ID is positively associated with being breastfed o6 months (Po0.05) and anemia and IDA with lower household income (Po0.05; Po0.01). Mean Hb was significantly lower (Po0.001) and mean EP was significantly higher (Po0.001) than those within children living in the United States. Conclusion: To meet Healthy People 2010 goals in children aged 1-2 years, the prevalence of ID in children living in American Samoa would need to decrease from 83 to 5% and in children aged 3-5 years from 59 to 1%. It is critical to ensure that populations within the United States and its territories are provided appropriate resources to promote health and prevent disease.

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Section: Resultsmentioning

confidence: 99%

Iron deficiency and anemia: disparity exists between children in American Samoa and children living within the US

2007

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“…It has been proposed that 'socioeconomic status gaps in child mortality are not simply inequalities, they are also inequities -inequalities that are unjust and unfair' (Victora et al, 2003). Given South Africa's past, ensuring equity is a key issue in the development of health and related social development policy.…”

Section: Resultsmentioning

confidence: 99%

Levels and Differentials in Childhood Mortality in South Africa, 1977–1998

et al. 2007

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SummaryThis study uses the 1996 Census and the 1998 Demographic and Health Survey (DHS) to investigate the level of and trend in infant and child mortality and their covariates in South Africa. Census estimates of childhood mortality are higher than those from the DHS. Analysis suggests that the former overestimate mortality while the latter are probably slightly too low. Both inquiries document a reversal of the trend toward lower mortality in the 1990s. Under-five mortality increased by about a third during the five years up to early 1998. By then the infant mortality rate was about 55 per 1000 and under-five mortality 72 per 1000. Other factors may explain the tapering off of the decline in mortality after the late 1980s but AIDS deaths account for its increase. Inequalities in childhood mortality between population groups, rooted in past discriminatory apartheid policies, shrank between the late-1970s and mid-1990s. However, they remain substantial and are largely unaccounted for by province, metropolitan residence and inter-group differences in mothers’ education. The HIV/AIDS epidemic is likely to offset the beneficial impact of post-apartheid pro-poor policies and may exacerbate racial differences in childhood mortality in South Africa. There is an urgent need to improve the routine collection of statistics to monitor child mortality so as to assess progress towards the Millennium Development Goals and track inequalities.

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“…It has been reported that rapid progress in child health outcomes can increase health inequities 41, but that is not always the case. The investments in health during the Nicaraguan revolution prioritised the underserved rural population and the poorer segments of society, resulting in a reduced social gap in child survival 4.…”

Section: Future Challengesmentioning

confidence: 99%

“…An equity lens should not only be used to visualise gender differences and socio‐economic gaps in child health 41. In some parts of the world, urban–rural differences are increasing, with the urban poor often living in the huge slum settlements of the mega cities in Asia, Africa and Latin America 45.…”

Section: Future Challengesmentioning

confidence: 99%

Child survival revolutions revisited – lessons learned from Bangladesh, Nicaragua, Rwanda and Vietnam

et al. 2017

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Analysing child mortality may enhance our perspective on global achievements in child survival. We used data from surveillance sites in Bangladesh, Nicaragua and Vietnam and Demographic Health Surveys in Rwanda to explore the development of neonatal and under‐five mortality. The mortality curves showed dramatic reductions over time, but child mortality in the four countries peaked during wars and catastrophes and was rapidly reduced by targeted interventions, multisectorial development efforts and community engagement. Conclusion: Lessons learned from these countries may be useful when tackling future challenges, including persistent neonatal deaths, survival inequalities and the consequences of climate change and migration.

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Applying an equity lens to child health and mortality: more of the same is not enough

Cited by 619 publications

References 16 publications

Iron deficiency and anemia: disparity exists between children in American Samoa and children living within the US

Iron deficiency and anemia: disparity exists between children in American Samoa and children living within the US

Levels and Differentials in Childhood Mortality in South Africa, 1977–1998

Child survival revolutions revisited – lessons learned from Bangladesh, Nicaragua, Rwanda and Vietnam

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